Individual
DR. HENRY F. DOMKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 W HIGH ST, JEFFERSON CITY, MO 65101-1525
(573) 634-5400
(573) 636-2639
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 634-5400
(573) 636-2639
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R6A79
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201319514
—
MO
Enumeration date
01/19/2006
Last updated
07/31/2008
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