Organization
DOUGLASS T. DOMOTO, M.D., J.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLASS TAKASHI DOMOTO M.D., J.D. (PRESIDENT)
(314) 535-3720
Entity
Organization
Contact information
Practice address
2606 CLARK AVE, AVE, SAINT LOUIS, MO 63103-2502
(314) 535-3720
(314) 535-7391
Mailing address
2606 CLARK AVE, SAINT LOUIS, MO 63103-2502
(314) 535-3720
(314) 535-7391
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
R6C21
MO
Other
Enumeration date
10/05/2010
Last updated
10/05/2010
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