Healthcare Provider Details

I. General information

NPI: 1184990731
Provider Name (Legal Business Name): DOMINIQUE IGOE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 MADISON SQUARE DR 100
LOVELAND CO
80538-3396
US

IV. Provider business mailing address

PO BOX 40065
DENVER CO
80204-0065
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-9451
  • Fax: 970-416-9676
Mailing address:
  • Phone: 720-580-8001
  • Fax: 720-580-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3369
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: