1. Home
  2. Directory
  3. Arizona
  4. Lakeside
  5. Physician Assistant
  6. NPI Profile

RICHARD E DONNELLY P.A.-C.
NPI 1396729455
Physician Assistant - Surgical in Lakeside, AZ

Active since December 02, 2005
43 W. WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929(928) 367-4040(928) 367-4042 Get Directions Write a Review

NPPES record last updated: February 16, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Richard E Donnelly P.a.-c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RICHARD E DONNELLY P.A.-C. (NPI 1396729455) is an individual surgical provider in Lakeside, Arizona, licensed in Arizona (1105) and active in the NPI registry since December 2005.

NPPES Registry Identity

NPI1396729455
Entity TypeIndividualMale
Primary Taxonomy363AS0400X
Provider Legal NameRICHARD E DONNELLYCredential: P.A.-C.
Location Address43 W. WHITE MOUNTAIN BLVDLakeside, AZ 85929-7002
Mailing Address43 W White Mountain BlvdLakeside, AZ 85929-7002 · (928) 367-4040 · Fax (928) 367-4042
Phone(928) 367-4040
Fax(928) 367-4042
Sole ProprietorYes
Enumeration DateDecember 2, 2005
Last NPPES UpdateFebruary 16, 2011
✔ NPI 1396729455 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
Licenses✔ Licensed in AZ · 1105✔ Licensed in MN · 10186
43 W. WHITE MOUNTAIN BLVD, Lakeside, AZ 85929
Open in Google Maps ↗

Other Identifiers 8

Other86080015085259A253AZ · Triwest
Other970001299AZ · Railroad Medicare
Medicare UPINR10773
Medicare ID-Type UnspecifiedPA1105AZ
Medicare ID-Type UnspecifiedP00338849MN · Railroad
Medicare ID-Type Unspecified970002638MN
Medicaid558930400MN
Medicaid342254AZ

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Richard Donnelly's NPI number?

The NPI number for Richard Donnelly is 1396729455. It was assigned to this individual provider in the NPPES registry on December 2, 2005.

Where is Richard Donnelly located?

Richard Donnelly practices at 43 W. White Mountain Blvd, Lakeside, AZ 85929. The listed phone number is (928) 367-4040.

What is Richard Donnelly's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

When was this NPI record last updated?

The NPPES record for Richard Donnelly was last updated on February 16, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.