Individual
DR. JEROME TAYMON DOMZALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-4748
(309) 655-2000
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036-164444
IL
2085R0202X
Diagnostic Radiology Physician
M-14669
ID
2085R0202X
Diagnostic Radiology Physician
MD185931
OR
2085R0202X
Diagnostic Radiology Physician
MD60808674
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0384868
LNI TRA-MINW, PS REST OF WA COUNTIES
WA
01
—
0384879
LNI TRA-MINW, PS KING COUNTY
WA
01
—
0384883
LNI UAOM
WA
01
—
0384886
LNI DINW
WA
01
—
0408166
LNI RADIA REST OF WA
WA
01
—
0408168
LNI RADIA KING COUNTY
WA
01
—
0408171
LNI SWEDISH RADIA EDMONDS
WA
01
—
0408173
LNI EVERGREEN RADIA
WA
01
—
0408174
LNI SOUTH SOUND RADIOLOGY
WA
01
—
0408176
LNI SEATTLE RADIOLOGY
WA
05
—
2094399
—
WA
Enumeration date
06/25/2009
Last updated
10/23/2023
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