Individual
CAL ANTHONY DOMINGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5000 AMBASSADOR CAFFERY PKWY BLDG 14A, LAFAYETTE, LA 70508-6984
(337) 470-3580
(337) 470-3586
Mailing address
PO BOX 54422, NEW ORLEANS, LA 70154-4422
(337) 470-3580
(337) 470-3586
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
A10610
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1624861
—
LA
01
—
P00220721
RR MEDICARE
LA
Enumeration date
12/09/2005
Last updated
12/31/2015
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