Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME110378 | FL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME110378 | FL |
N | 2086S0127X | Trauma Surgeon | ME110378 | FL |
NPI | 1467694521 |
---|---|
Provider Name | Dr. David E. Dominguez |
First Address | Indialantic, FL 32903-2607 |
Second Address | Indialantic, FL 32903-2607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2009 |
Last Update Date | 19/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003772300 | (05) | FL |