Individual
DR. DOMINADOR YTI LAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
RT 10 APPALACHAIN HWY. EAST PINEVILLE, PINEVILLE, WV 24874-1274
(304) 732-9045
(304) 732-9055
Mailing address
PO BOX 1274, PINEVILLE, WV 24874-1274
(304) 732-9045
(304) 732-9055
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12700
WV
208600000X
Surgery Physician
12700
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720313
BLUE CROSS/BLUE SHIELD
WV
05
—
0128304001
—
WV
01
—
1220372
CHA HEALTH
WV
Enumeration date
08/29/2006
Last updated
02/14/2011
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