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General NPI Number Information
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NPI Number | 1144209552
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Entity Type | Individual
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Provider Name | RICHARD TODD DOMBROSKI DO
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Gender | Male
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 6913 CAMP BOWIE BLVD STE 107
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City | FORT WORTH
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State | TX
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Zip | 76116-7164
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Country | US
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Telephone | 817-367-9289
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Fax |
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Provider Business Mailing Address
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Address Line | 8332 WHIPPOORWILL DR
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City | FORT WORTH
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State | TX
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Zip | 76123-1994
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Country | US
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Telephone | 817-412-0877
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | Q3358
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | Q3358
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | Q3358
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License Number State | TX
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