Provider Demographics
NPI:1730613381
Name:GINEST, DONAVAN
Entity type:Individual
Prefix:
First Name:DONAVAN
Middle Name:
Last Name:GINEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12045 SW ASPEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2569
Mailing Address - Country:US
Mailing Address - Phone:971-297-7788
Mailing Address - Fax:
Practice Address - Street 1:8450 KELSALL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6323
Practice Address - Country:US
Practice Address - Phone:541-740-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD198409207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine