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Individual

MARTINE CATHERINE DOMANGUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
313027
LA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2495445
LA
01
313027
LOUISIANA LICENSE
LA
01
CDS.055295-INT
CDS LICENSE
LA
Enumeration date
04/26/2018
Last updated
09/16/2019
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