Provider Demographics
NPI:1417942400
Name:DONNELLY, JAMES W (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3651
Mailing Address - Country:US
Mailing Address - Phone:314-576-1411
Mailing Address - Fax:314-576-2850
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:SUITE 710N
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-576-1411
Practice Address - Fax:314-576-2850
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2025-08-11
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Provider Licenses
StateLicense IDTaxonomies
MOMDR8G56207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA13789Medicare UPIN