Individual
TEAGUE DOMBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 17TH AVE E, ALEXANDRIA, MN 56308-5273
(320) 762-1511
Mailing address
111 17TH AVE E, ALEXANDRIA, MN 56308-5273
(320) 762-1511
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
47497
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096660600
—
MN
01
—
47497
MEDICAL LICENSE
MN
Enumeration date
03/18/2006
Last updated
10/21/2024
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