Individual
THOMAS JOSEPH DOMINGUEZ IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
267 GRANT ST, BRIDGEPORT, CT 06610-2870
(203) 502-4723
Mailing address
267 GRANT ST, BRIDGEPORT, CT 06610-2870
(203) 502-4723
(475) 246-9952
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
4269
CT
363AS0400X
Surgical Physician Assistant
Primary
PA9113032
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105929600
—
FL
01
—
UR442
MEDICARE HF
FL
Enumeration date
09/11/2018
Last updated
03/12/2025
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