Basic Information
| Provider Information | |||||||||
| NPI: | 1780641431 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONALDSON | ||||||||
| FirstName: | ELVIS | ||||||||
| MiddleName: | SMITH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 910670 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405910670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599714685 | ||||||||
| FaxNumber: | 8599714602 | ||||||||
| Practice Location | |||||||||
| Address1: | 1780 NICHOLASVILLE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592785671 | ||||||||
| FaxNumber: | 8592785978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 05/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | 16232 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 207RX0202X | 16232 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 64162324 | 05 | KY | MEDICAID |