Healthcare Provider Details

I. General information

NPI: 1508593831
Provider Name (Legal Business Name): DOMINIQUE GAGNON M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S SUNSET AVE
LITTLEFIELD TX
79339-4810
US

IV. Provider business mailing address

300 E 13TH ST
LITTLEFIELD TX
79339-4516
US

V. Phone/Fax

Practice location:
  • Phone: 806-385-6424
  • Fax:
Mailing address:
  • Phone: 806-368-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE GAGNON
Title or Position: FAMILY MEDICINE PHYSICIAN
Credential: M.D. PH.D.
Phone: 806-368-1891