Individual
DOMINIC JAMES VERNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1130 W MICHIGAN ST STE 400, INDIANAPOLIS, IN 46202-5209
(317) 944-5000
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01082463A
IN
207Y00000X
Otolaryngology Physician
D84871
MD
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
01082463A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001300219
ANTHEM PTAN
IN
05
—
300029615
—
IN
Enumeration date
05/17/2013
Last updated
04/11/2025
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