Individual
DR. DOMINADOR T PERIDO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
411 SUNSET, ELKHART, KS 67950-0997
(620) 697-2155
(620) 697-4275
Mailing address
PO BOX 997, ELKHART, KS 67950-0997
(620) 697-2155
(620) 697-4275
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
KS0416343
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100085400A
—
KS
Enumeration date
08/26/2005
Last updated
08/08/2012
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