Provider Demographics
NPI:1821989963
Name:DONJUAN, MARTIN (PA-C)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:DONJUAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 MULLICANE LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7830
Mailing Address - Country:US
Mailing Address - Phone:214-558-5461
Mailing Address - Fax:
Practice Address - Street 1:221 WEST COLORADO BLVD
Practice Address - Street 2:PAVILLION 2, SUITE 933
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:214-947-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical