Individual
ANDREW RICHARD DOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3920 N UNION BLVD STE 330, COLORADO SPRINGS, CO 80907-4916
(719) 570-7272
(719) 570-9030
Mailing address
8101 E LOWRY BLVD, STE 120, DENVER, CO 80230-7195
(303) 806-1998
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4155
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11561458
CAQH NUMBER
—
Enumeration date
06/09/2006
Last updated
06/11/2021
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