Individual
MARK R DOMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
260 HIGHWAY 11 E, BULLS GAP, TN 37711-3416
(423) 235-4191
(423) 235-7092
Mailing address
PO BOX 850, ROGERSVILLE, TN 37857-0850
(423) 235-4191
(423) 235-7092
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21947
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3094672
—
TN
Enumeration date
06/22/2005
Last updated
08/29/2011
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