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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