Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | N1615 | TX |
Y | 207XS0106X | Orthopaedic Hand Surgeon | N1615 | TX |
NPI | 1336370527 |
---|---|
Provider Name | Dr. Donald Dean Dominy III |
First Address | Sugar Land, TX 77479-4728 |
Second Address | Sugar Land, TX 77479-4728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2009 |
Last Update Date | 10/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1336370527 | BLUE CROSS BLUE SHIELD (01) | TX |
307642401 | (05) | TX |
307642402 | (05) | TX |
307642403 | (05) | TX |
307642404 | (05) | TX |
307642405 | (05) | TX |
307642406 | (05) | TX |
P01170515 | RR MEDICARE (01) | TX |
P01258412 | MEDICARE RR (01) | TX |