Individual
DR. STEPHEN ROBERT DOMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
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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