Healthcare Provider Details

I. General information

NPI: 1841201597
Provider Name (Legal Business Name): DOMINION MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 W PARMER LN SUITE 102
AUSTIN TX
78729-6801
US

IV. Provider business mailing address

6301 W PARMER LN SUITE 102
AUSTIN TX
78729-6801
US

V. Phone/Fax

Practice location:
  • Phone: 512-834-9999
  • Fax: 512-834-9998
Mailing address:
  • Phone: 512-834-9999
  • Fax: 512-834-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK8564
License Number StateTX

VIII. Authorized Official

Name: KIMBERLY WARFIELD
Title or Position: PRESIDENT
Credential: MD
Phone: 512-834-9999