Mark Flavius Donaldson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C41496 Issued in CA

Practice address

1288 Morro St
Suite 200
San Luis Obispo, CA 93401-6301

Phone

(805) 543-1233

Fax

(805) 547-1179

NPI assigned

Jun 22, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710923933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1288 MORRO ST",
            "address_2": "SUITE 200",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016301",
            "telephone_number": "805-543-1233",
            "fax_number": "805-547-1179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1288 MORRO ST",
            "address_2": "SUITE 200",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016301",
            "telephone_number": "805-543-1233",
            "fax_number": "805-547-1179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONALDSON",
        "first_name": "MARK",
        "middle_name": "FLAVIUS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C41496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Dominguez
• Amber Nicole Dominguez
• Chiyeko Dominguez
• Veronica Dominguez
• Donald a. Ramberg M.D., Inc.
• Alba Leticia Donovan, PHD
• Dawn Donovan
• Savannah Michele Donovan
• Allen Doran, M.D.
• Robert J Doria, MD, FACC

• Internal Medicine Physician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.