Individual
DR. DOUGLASS TAKASHI DOMOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., J.D.
Contact information
Practice address
2606 CLARK AVE, SAINT LOUIS, MO 63103-2502
(314) 535-3720
(324) 525-7391
Mailing address
2606 CLARK AVE, SAINT LOUIS, MO 63103-2502
(314) 535-3720
(324) 525-7391
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
R6C21
MO
Other
Enumeration date
09/25/2006
Last updated
07/08/2007
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