MEDICARE: DR. AZIZ S DOUMIT M.D.

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
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	MD101729	MO

General Provider Information

NPI Number	:	1801826847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AZIZ S DOUMIT M.D.

Provider Business Mailing Address
First Line	:	4006 HIGHWAY D
Second Line	:
City	:	DEFIANCE
State	:	MO
Zip	:	63341-1726
Country	:	US
Telephone Number	:	314-852-7507
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 W HIGHWAY D
Second Line	:	SUITE 201A
City	:	NEW MELLE
State	:	MO
Zip	:	63365-9998
Country	:	US
Telephone Number	:	636-398-8188
Fax Number	:	636-828-4442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/31/2015

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