Individual
DR. DANIEL DOMJAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 SOUTHLAND DR, SIKESTON, MO 63801-4403
(573) 472-1770
(573) 472-4050
Mailing address
6738 STATE HIGHWAY 77, BENTON, MO 63736-8238
(573) 313-2500
(573) 313-2505
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
118085
MO
208D00000X
General Practice Physician
Primary
118085
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204706030
—
MO
Enumeration date
01/18/2006
Last updated
03/12/2020
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