Individual
MARK JASON DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
606 W 11TH AVE, COVINGTON, LA 70433-3630
(985) 892-3766
(985) 893-9567
Mailing address
PO BOX 54482, NEW ORLEANS, LA 70154-4482
(985) 898-3740
(985) 898-3739
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
200251
LA
Other
Enumeration date
05/21/2007
Last updated
03/16/2016
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