Individual
DR. JUAN C DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5210 NORTH BELT HWY, SAINT JOSEPH, MO 64506-1211
(816) 271-4995
(816) 271-4915
Mailing address
5210 NORTH BELT HWY, SAINT JOSEPH, MO 64506-1211
(816) 271-4995
(816) 271-4915
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
118268
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001381300
COMMUNITY HEALTH PLAN
MO
05
—
100381150A
—
KS
01
—
2180287
AETNA
MO
05
—
246807846
—
MO
01
—
25683028
BLUE CROSS/BLUE SHIELD KC
MO
01
—
26D0896653
CLIA
MO
01
—
403973
BLUE CROSS/BLUE SHIELD KS
KS
Enumeration date
07/17/2006
Last updated
11/20/2017
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