Organization
GRAND ANESTHESIOLOGY SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARC DOMSKY D.O. (PRESIDENT)
(307) 739-7218
Entity
Organization
Contact information
Practice address
625 E BROADWAY, JACKSON, WY 83001
(800) 877-7078
(307) 739-7446
Mailing address
PO BOX 1501, IDAHO FALLS, ID 83403-1501
(208) 525-2090
(208) 525-2662
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
07/28/2006
Last updated
03/03/2008
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