Provider Demographics
NPI:1285484790
Name:POUNDS, DONALD E JR
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:POUNDS
Suffix:JR
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 1:134 S 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-1702
Mailing Address - Country:US
Mailing Address - Phone:231-495-8284
Mailing Address - Fax:
Practice Address - Street 1:134 S 11TH AVE
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1702
Practice Address - Country:US
Practice Address - Phone:231-495-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X
IN171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore Provider