Individual
COLETTE DOMINIQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4429 CLARA ST, NEW ORLEANS, LA 70115-6902
(504) 842-9885
(504) 842-9836
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
303382
LA
207V00000X
Obstetrics & Gynecology Physician
L9182
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168588501
—
TX
01
—
8AJ839
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/23/2005
Last updated
03/04/2021
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