Healthcare Provider Details

I. General information

NPI: 1447315734
Provider Name (Legal Business Name): DOMINIQUE DARMAUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CHILDRENS WAY NEMOURS CHILDREN'S CLINIC, RESEARCH 5NORTH
JACKSONVILLE FL
32207-8426
US

IV. Provider business mailing address

807 CHILDREN'S WAY NEMOURS CHILDREN'S CLINIC, RSEARCH 5NORTH
JACKSONVILLE FL
32207
US

V. Phone/Fax

Practice location:
  • Phone: 904-390-3488
  • Fax: 904-390-3425
Mailing address:
  • Phone: 904-390-3488
  • Fax: 904-390-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME 59396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: