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General NPI Number Information
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NPI Number | 1538208038
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Entity Type | Individual
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Provider Name | JORGE E DOMINGUEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 3150 INTERNATIONAL BLVD
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City | BROWNSVILLE
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State | TX
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Zip | 78521-3214
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Country | US
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Telephone | 956-548-1100
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Fax | 956-504-1907
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Provider Business Mailing Address
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Address Line | 3150 INTERNATIONAL BLVD
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City | BROWNSVILLE
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State | TX
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Zip | 78521-3214
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Country | US
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Telephone | 956-548-1100
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Fax | 956-504-1907
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | H3561
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | H3561
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License Number State | TX
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