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General NPI Number Information
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NPI Number | 1033205091
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Entity Type | Individual
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Provider Name | DOMINIQUE MESIDOR MD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 2010 59TH ST W SUITE 2200
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City | BRADENTON
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State | FL
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Zip | 34209-4616
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Country | US
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Telephone | 941-794-5621
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Fax | 941-761-1532
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Provider Business Mailing Address
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Address Line | 2010 59TH ST W SUITE 2200
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City | BRADENTON
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State | FL
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Zip | 34209-4616
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Country | US
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Telephone | 941-794-5621
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Fax | 941-761-1532
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | ME0086398
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 044539
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License Number State | GA
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