Organization
DOMINADOR T. PERIDO MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMINADOR T. PERIDO M.D. (OWNER)
(620) 697-2155
Entity
Organization
Contact information
Practice address
411 SUNSET, ELKHART, KS 67950-0997
(620) 697-2155
(620) 697-4275
Mailing address
PO BOX 997, ELKHART, KS 67950-0997
(620) 697-2155
(620) 697-4275
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
KS04-16343
KS
208600000X
Surgery Physician
Primary
KS04-16343
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100085400A
—
KS
Enumeration date
08/31/2006
Last updated
07/27/2012
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