Individual
ETHAN ROSS DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
38135 MARKET SQUARE DR STE 103, ZEPHYRHILLS, FL 33542-7505
(813) 815-5400
Mailing address
38135 MARKET SQUARE DR STE 103, ZEPHYRHILLS, FL 33542-7505
(813) 815-5400
(813) 355-5074
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22271
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
AR
Other
Enumeration date
03/29/2022
Last updated
06/05/2025
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