Individual
DR. MOISES B. DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 HOSPITAL DR, HARRISBURG, IL 62946-2453
(618) 252-5126
(618) 252-0135
Mailing address
PO BOX 15040, EVANSVILLE, IN 47716-0040
(812) 476-1367
(812) 477-4153
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01032966
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036066172
—
IL
05
—
100319850
—
IN
Enumeration date
02/13/2006
Last updated
09/15/2008
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