Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | B1556 | TX |
NPI | 1417931239 |
---|---|
Provider Name | Dr. Charles Chester Domingues |
First Address | Beaumont, TX 77707-2216 |
Second Address | Beaumont, TX 77707-2216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 10/07/2007 |