# ANTHONY M DOMINIC SR DO PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922006204
- **Authorized official:** DR. ANTHONY M DOMINIC SR. DO (PRESIDENT)
- **Authorized official phone:** (480) 982-1265

## Contact information

- **Practice address:** 850 S IRONWOOD DR, STE 104, APACHE JUNCTION, AZ 85220-6242
- **Practice address phone:** (480) 982-1265
- **Practice address fax:** (480) 982-8831
- **Mailing address:** 850 S IRONWOOD DR, STE 104, APACHE JUNCTION, AZ 85220-6242
- **Mailing address phone:** (480) 982-1265
- **Mailing address fax:** (480) 982-8831

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 1833 | AZ | Yes |
| 207Q00000X | Family Medicine Physician | 34002451 | OH | — |

## Other

- **Enumeration date:** 07/12/2005
- **Last updated:** 01/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 160127 | — | AZ |
| 01 | — | 1Z0948 | HEALTHNET | AZ |
| 01 | — | AZ0390340 | BCBS | AZ |