Individual
DR. THERESA DOMERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
172 W WOODGLEN RD, SPARTANBURG, SC 29301-5305
(864) 278-8542
Mailing address
172 W WOODGLEN RD, SPARTANBURG, SC 29301-5305
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
22953
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
189204
MEDCOST
SC
01
—
20051869
SELECT HEALTH
SC
05
—
229531
—
SC
01
—
5024654
AETNA
SC
05
—
5902063
—
NC
Enumeration date
01/26/2006
Last updated
02/23/2014
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