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NPI Code Detail

MEDICARE: FERNANDO E DOMINGO M.D.

MEDICARE: FERNANDO E DOMINGO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2208200000XPlastic Surgery Physician57447TN

General Provider Information

NPI Number : 1801154935
Entity Type Code : Individual
Provider Name (Legal Business Name) : FERNANDO E DOMINGO M.D.
Provider Business Mailing Address
First Line : 900 RIVERFRONT PKWY STE 100
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37402-2101
Country : US
Telephone Number : 423-756-7134
Fax Number :
Provider Business Practice Location Address
First Line : 901 RIVERFRONT PKWY STE 100
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37402-2193
Country : US
Telephone Number : 423-763-4549
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2012
Last Update Date : 06/30/2021

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Directions to “ FERNANDO E DOMINGO M.D.” Practice Location

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