Healthcare Provider Details

I. General information

NPI: 1932930518
Provider Name (Legal Business Name): ZANE JOSEPH DOMANGUE PLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CIVIC CENTER BLVD
HOUMA LA
70360-5937
US

IV. Provider business mailing address

807 1/2 LIBERTY ST
HOUMA LA
70360-4738
US

V. Phone/Fax

Practice location:
  • Phone: 985-226-1028
  • Fax:
Mailing address:
  • Phone: 985-991-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC10872
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: