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Individual

JESUS H DOMINGUEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1481 W 10TH ST, C7173, INDIANAPOLIS, IN 46202-2803
(317) 274-7453
Mailing address
PO BOX 44994, INDIANAPOLIS, IN 46244-0994
(317) 274-4402
(317) 274-5168

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01034356
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100260790
IN
Enumeration date
05/01/2006
Last updated
01/21/2021
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