Healthcare Provider Details

I. General information

NPI: 1801240577
Provider Name (Legal Business Name): DOMINQUE VANBEEST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DOMINIQUE VAN BEEST

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 S LOOP 340
ROBINSON TX
76706-4828
US

IV. Provider business mailing address

2637 N 400 E STE 164
NORTH OGDEN UT
84414-2240
US

V. Phone/Fax

Practice location:
  • Phone: 254-523-2200
  • Fax:
Mailing address:
  • Phone: 214-970-6817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberU7072
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberMD.MD.61176256
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: