Individual
DR. TIMOTHY P DOMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
16687 SAINT CLAIR AVE, SUITE 101, EAST LIVERPOOL, OH 43920-9401
(330) 385-4610
(330) 385-4620
Mailing address
16687 SAINT CLAIR AVE, SUITE 101, EAST LIVERPOOL, OH 43920-9401
(330) 385-4610
(330) 385-4620
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
34005918D
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2000798000
—
WV
05
—
2069998
—
OH
Enumeration date
03/31/2006
Last updated
10/18/2011
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