Provider Demographics
NPI:1083080535
Name:DOMINGUEZ, LUIS WILLIAM (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:WILLIAM
Last Name:DOMINGUEZ
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW
Mailing Address - Street 2:GW MFA DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - City:WASHINGTON DC
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-798-0100
Mailing Address - Fax:202-379-3570
Practice Address - Street 1:2150 PENNSYLVANIA AVE
Practice Address - Street 2:GW MEDICAL FACULTY ASSOCIATES, DEPT OF EMERG. MED.
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-798-0100
Practice Address - Fax:202-379-3570
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2018-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DCMD046182207R00000X
MDD0085304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD046182OtherLICENSE NUMBER