Organization
DAVID J DOMIN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J DOMIN MD (PRESIDENT)
(602) 264-1395
Entity
Organization
Contact information
Practice address
5133 N CENTRAL AVE, STE 200, PHOENIX, AZ 85012-1438
(602) 264-1395
(602) 264-2172
Mailing address
5133 N CENTRAL AVE, STE 200, PHOENIX, AZ 85012-1438
(602) 264-1395
(602) 264-2172
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
30234
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
761032
—
AZ
01
—
AZ0721260
BLUE CROSS BLUE SHIELD AZ
AZ
Enumeration date
08/21/2006
Last updated
03/17/2008
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