Individual
MAXFELONILO A DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
760 SE 5TH TERRACE, CRYSTAL RIVER, FL 34429-4852
(352) 795-4165
(352) 795-3659
Mailing address
308 W HIGHLAND BLVD, INVERNESS, FL 34452-4716
(352) 726-8353
(352) 726-5038
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME0043605
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000755600
—
FL
01
—
06004119
RAILROAD MEDICARE
FL
01
—
11379665
CAQH
FL
01
—
269859500
MEDICAID GROUP
FL
01
—
592123944
CIGNA
FL
01
—
77940
MEDICARE GROUP ID
FL
01
—
79947
BS OF FL
FL
01
—
CF1416
MEDICARE RR GROUP
FL
01
—
ME43605
STATE MEDICAL LICENSE
FL
Enumeration date
09/26/2007
Last updated
10/08/2009
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