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General NPI Number Information
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NPI Number | 1609989912
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Entity Type | Individual
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Provider Name | DOMINADOR L DAYON JR. M. D.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 7906 S CRANDON AVE SUITE #4
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City | CHICAGO
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State | IL
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Zip | 60617-1146
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Country | US
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Telephone | 773-768-5182
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Fax | 773-978-5930
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Provider Business Mailing Address
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Address Line | 7906 S CRANDON AVE SUITE #4
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City | CHICAGO
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State | IL
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Zip | 60617-1146
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Country | US
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Telephone | 773-768-5182
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Fax | 773-978-5930
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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 | 036052751
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License Number State | IL
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