Physician Compare National (NPI:1417001041)

HEALTHCARE PROVIDER: DANIEL SCOTT DOMROSE DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1417001041
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628237930
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120306000651
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DOMROSE
	Individual professional last name
Provider First Name	DANIEL
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CALIFORNIA SCHOOL OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2440 NW PROFESSIONAL DR
	Group Practice or individual's line 1 address
City	CORVALLIS
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	973303991
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5417549665
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y