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NPI Code Detail

MEDICARE: DR. JEFFREY TODD DOMINGUE D.P.M.

MEDICARE: DR. JEFFREY TODD DOMINGUE D.P.M.
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
1213ES0103XFoot & Ankle Surgery Podiatrist682CO
2213ES0103XFoot & Ankle Surgery Podiatrist237SD

General Provider Information

NPI Number : 1962418178
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY TODD DOMINGUE D.P.M.
Provider Business Mailing Address
First Line : 1200 S 7TH AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57105-0900
Country : US
Telephone Number : 605-782-8305
Fax Number : 605-336-1677
Provider Business Practice Location Address
First Line : 2100 S MARION RD
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57106-3646
Country : US
Telephone Number : 605-322-5180
Fax Number : 605-322-1301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 07/16/2019

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