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General NPI Number Information
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NPI Number | 1730106329
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Entity Type | Individual
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Provider Name | BRUCE L DOMM MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 5 9TH AVE N
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City | CASSELTON
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State | ND
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Zip | 58012-3339
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Country | US
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Telephone | 701-347-4445
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Fax | 701-347-5276
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Provider Business Mailing Address
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Address Line | PO BOX 6001
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City | FARGO
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State | ND
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Zip | 58108-6001
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Country | US
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Telephone | 701-364-3300
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Fax | 701-364-8906
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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 | 5341
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License Number State | ND
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