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General NPI Number Information
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NPI Number | 1831180082
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Entity Type | Individual
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Provider Name | JAMES DOMESEK MD
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Gender | Male
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 1314 E LAS OLAS BLVD STE 898
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2334
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Country | US
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Telephone | 954-540-5410
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Fax | 772-460-6563
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Provider Business Mailing Address
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Address Line | 1314 E LAS OLAS BLVD STE 898
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2334
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Country | US
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Telephone | 954-540-5410
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Fax | 772-460-6563
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | MD039114L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | ME86904
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License Number State | FL
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