| Richard E Donnelly, PA-C | |
|
43 W. White Mountain Blvd, Lakeside, AZ 85929-7002 | |
| (928) 367-4040 | |
| (928) 367-4042 |
| Full Name | Richard E Donnelly |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant - Surgical |
| Location | 43 W. White Mountain Blvd, Lakeside, Arizona |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396729455 | NPI | - | NPPES |
| 86080015085259A253 | Other | AZ | TRIWEST |
| 558930400 | Medicaid | MN | |
| 342254 | Medicaid | AZ | |
| 970001299 | Other | AZ | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AS0400X | Physician Assistant - Surgical | 1105 (Arizona) | Primary |
| 363AS0400X | Physician Assistant - Surgical | 10186 (Minnesota) | Secondary |
| Mailing Address | Practice Location Address |
|---|---|
| Richard E Donnelly, PA-C 43 W White Mountain Blvd, Lakeside, AZ 85929-7002 Ph: (928) 367-4040 | Richard E Donnelly, PA-C 43 W. White Mountain Blvd, Lakeside, AZ 85929-7002 Ph: (928) 367-4040 |
Mr. Steven K Struthers, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 4830 Highway 260 Ste 103, Lakeside, AZ 85929 Phone: 928-537-8777 Fax: 928-537-1914 | |
Linda Diane Teague, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 2963 W White Mountain Blvd, Lakeside, AZ 85929 Phone: 928-368-0765 Fax: 928-368-4540 |