Healthcare Provider Details

I. General information

NPI: 1619965472
Provider Name (Legal Business Name): ROBERT JAVIER DOMINGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 E MAIN ST
LANCASTER OH
43130-3983
US

IV. Provider business mailing address

784 E MAIN ST
LANCASTER OH
43130-3983
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-0100
  • Fax: 740-687-0145
Mailing address:
  • Phone: 740-687-0100
  • Fax: 740-687-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35053076D
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35053076D
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35053076D
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: