Provider Demographics
NPI:1497761761
Name:ISAAC, DOMINIQUE J (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:J
Last Name:ISAAC
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4515 SETON CENTER PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5290
Mailing Address - Country:US
Mailing Address - Phone:512-231-5506
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:10401 ANDERSON MILL RD
Practice Address - Street 2:SUITE 110B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2581
Practice Address - Country:US
Practice Address - Phone:512-250-5571
Practice Address - Fax:512-406-7300
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-01-05
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Provider Licenses
StateLicense IDTaxonomies
TXM3270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179537901Medicaid
TX179537902Medicaid
TXP00401342Medicaid
TX8K0592Medicare PIN
TX8G5513Medicare PIN