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NPI Code Detail

MEDICARE: CAL ANTHONY DOMINGUE PA

MEDICARE:   CAL ANTHONY DOMINGUE  PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantA10610LA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00220721OTHERLARR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437134707
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAL ANTHONY DOMINGUE PA
Provider Business Mailing Address
First Line : PO BOX 54422
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70154-4422
Country : US
Telephone Number : 337-470-3580
Fax Number : 337-470-3586
Provider Business Practice Location Address
First Line : 5000 AMBASSADOR CAFFERY PKWY BLDG 14A
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-6984
Country : US
Telephone Number : 337-470-3580
Fax Number : 337-470-3586
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2005
Last Update Date : 12/31/2015

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Directions to “ CAL ANTHONY DOMINGUE PA” Practice Location

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