Provider Demographics
NPI:1508593831
Name:DOMINIQUE GAGNON M.D. P.A.
Entity Type:Organization
Organization Name:DOMINIQUE GAGNON M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:806-368-1891
Mailing Address - Street 1:300 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-4516
Mailing Address - Country:US
Mailing Address - Phone:806-368-1891
Mailing Address - Fax:
Practice Address - Street 1:1600 S SUNSET AVE
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-4810
Practice Address - Country:US
Practice Address - Phone:806-385-6424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1508593831Medicaid
TX1548826605Medicaid