Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | POR188 | FL |
N | 222Z00000X | Podiatrist | POR188 | FL |
Y | 224P00000X | Prosthetist | POR188 | FL |
NPI | 1134220734 |
---|---|
Provider Name | Andrew Douglas Domb |
First Address | North Palm Beach, FL 33408-4903 |
Second Address | North Palm Beach, FL 33408-4903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 02/08/2010 |