Individual
DR. STEPHEN ROBERT DOMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
29 9TH AVE N, HOPKINS, MN 55343-8087
(952) 935-3334
(952) 935-1935
Mailing address
29 9TH AVE N, HOPKINS, MN 55343-8087
(952) 935-3334
(952) 935-1935
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
399
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04153DO
BLUE SHIELD
FM
01
—
2715056
MEDICA HEALTH PLAN
MN
Enumeration date
09/20/2006
Last updated
07/08/2007
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