Individual
DR. DOMINIC LEE PHEMISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 457-0469
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036.155060
IL
207P00000X
Emergency Medicine Physician
125.072370
IL
Other
Enumeration date
06/07/2018
Last updated
07/02/2021
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