Provider Demographics
NPI:1497730097
Name:OFFIONG, DOMINIC A (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:A
Last Name:OFFIONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 11TH STREET
Mailing Address - Street 2:UNIT B
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4332
Mailing Address - Country:US
Mailing Address - Phone:940-263-3000
Mailing Address - Fax:940-263-3018
Practice Address - Street 1:1631 11TH STREET
Practice Address - Street 2:UNIT B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4332
Practice Address - Country:US
Practice Address - Phone:940-263-3000
Practice Address - Fax:940-263-3018
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058488A207R00000X
NY234371207R00000X, 208M00000X
TXM0845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W044OtherMEDICARE GROUP
TX00X144OtherMEDICARE GROUP
TX178763201Medicaid
TX8J8794OtherMEDICARE PTAN
TX0067NDOtherBCTX GROUP
TX1134298466OtherGROUP NPI
TX1356361976OtherGROUP NPI
TX1356361976OtherGROUP NPI
TXTXB122226Medicare PIN