Individual
BRUCE L DOMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5 9TH AVE N, CASSELTON, ND 58012-3339
(701) 347-4445
(701) 347-5276
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5341
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A28DO
MNBS #
ND
01
—
0106108
MEDICA #
ND
01
—
0106110
MEDICA #
ND
01
—
0108127
MEDICA #
ND
05
—
112583400
—
ND
01
—
142308
UCARE #
ND
05
—
15375
—
ND
01
—
336
NDBS #
ND
01
—
37983
SIOUX VALLEY #
ND
01
—
676560
AMERICA'S PPO/ARAZ #
ND
01
—
93416DO
MNBS 3
ND
01
—
DA9011015505
PREFERRED ONE #
ND
01
—
HP19507
HEALTHPARTNERS #
ND
01
—
ND100038
LHS #
MN
Enumeration date
07/17/2006
Last updated
10/17/2011
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