Individual
DR. E.L. DOMINGO-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 CHESTERFIELD BUSINESS PKWY FL 2, CHESTERFIELD, MO 63005-1271
(954) 399-4673
Mailing address
3601 SW 160TH AVE STE 250, MIRAMAR, FL 33027-6314
(954) 399-4673
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
2024043640
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2021
Last updated
12/26/2024
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