Individual
DR. DOMINIQUE MESIDOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2010 59TH ST W, SUITE 2200, BRADENTON, FL 34209-4616
(941) 794-5621
(941) 761-1532
Mailing address
2010 59TH ST W, SUITE 2200, BRADENTON, FL 34209-4616
(941) 794-5621
(941) 761-1532
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
044539
GA
2086S0127X
Trauma Surgery Physician
ME0086398
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267667200
—
FL
01
—
U1254X
MEDICARE
FL
Enumeration date
10/05/2006
Last updated
11/01/2017
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