Healthcare Provider Details

I. General information

NPI: 1497287841
Provider Name (Legal Business Name): LIORGE DOMINGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 LUCERNE TER
ORLANDO FL
32806-1015
US

IV. Provider business mailing address

52 W UNDERWOOD ST
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-1039
  • Fax: 407-425-2347
Mailing address:
  • Phone: 321-841-3581
  • Fax: 321-843-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME144226
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME144226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: