Healthcare Provider Details

I. General information

NPI: 1356471601
Provider Name (Legal Business Name): JAMES N. DOMINGUE M.D. APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 S COLLEGE RD SUITE 100
LAFAYETTE LA
70503-2907
US

IV. Provider business mailing address

1245 S COLLEGE RD SUITE 100
LAFAYETTE LA
70503-2907
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-5840
  • Fax: 337-237-7568
Mailing address:
  • Phone: 337-269-5840
  • Fax: 337-237-7568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number012702
License Number StateLA

VIII. Authorized Official

Name: DR. JAMES NEAL DOMINGUE
Title or Position: PRESIDENT
Credential: MD
Phone: 337-269-5840