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Organization

MAXFELONILO A DOMINGO MD PA

Active
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Organization

MAXFELONILO A DOMINGO MD PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MAXFELONILO A. DOMINGO M.D. (PRESIDENT)
(352) 795-4165
Entity
Organization

Contact information

Practice address
760 SE 5TH TER, CRYSTAL RIVER, FL 34429-4852
(352) 795-4165
Mailing address
PO BOX 2890, CRYSTAL RIVER, FL 34423-2890
(352) 795-4165

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME0043605
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
06004119
RAILROAD MEDICARE NUMBER
FL
Enumeration date
07/11/2006
Last updated
05/12/2008
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