Organization
RIVERSIDE SURGICAL AND WEIGHT LOSS CENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK W DOMKOWSKI MD, PHD,FACS (PRESIDENT)
(772) 581-8003
Entity
Organization
Contact information
Practice address
705 SEBASTIAN BLVD, SUITE D, SEBASTIAN, FL 32958-4397
(772) 581-8003
(772) 581-8005
Mailing address
705 SEBASTIAN BLVD., SUITE D, SEBASTIAN, FL 32958
(772) 581-8003
(772) 581-8005
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD89469
FL
Other
Enumeration date
01/27/2009
Last updated
05/07/2009
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