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General NPI Number Information
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NPI Number | 1609840248
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Entity Type | Individual
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Provider Name | DR. MOISES B. DOMINGO
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Gender | Male
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 20 HOSPITAL DR
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City | HARRISBURG
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State | IL
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Zip | 62946-2453
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Country | US
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Telephone | 618-252-5126
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Fax | 618-252-0135
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Provider Business Mailing Address
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Address Line | PO BOX 15040
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City | EVANSVILLE
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State | IN
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Zip | 47716-0040
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Country | US
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Telephone | 812-476-1367
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Fax | 812-477-4153
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 01032966
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License Number State | IN
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