Individual
NOEL R DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
209 WEST MAIN STREET, WAVERLY, TN 37185
(931) 296-4225
(931) 296-4218
Mailing address
P O BOX 210, WAVERLY, TN 37185
(931) 296-4225
(931) 296-4218
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD0000019861
TN
207R00000X
Internal Medicine Physician
ME57103
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81977
BC INDIV PROV #
FL
Enumeration date
06/05/2006
Last updated
10/07/2021
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