Individual
JOSE M DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3276
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
107891
MO
208C00000X
Colon & Rectal Surgery Physician
Primary
107891
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106986
BLUE CROSS/BLUE SHIELD
—
05
—
207976002
—
MO
Enumeration date
06/03/2006
Last updated
10/08/2025
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