Provider Demographics
NPI:1588796155
Name:DOMINGUE, SZU-WEI T (MD)
Entity Type:Individual
Prefix:DR
First Name:SZU-WEI
Middle Name:T
Last Name:DOMINGUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2150
Mailing Address - Country:US
Mailing Address - Phone:318-355-8152
Mailing Address - Fax:
Practice Address - Street 1:3301 DEBORAH DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2150
Practice Address - Country:US
Practice Address - Phone:318-325-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021807207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1676101Medicaid
LA5W707Medicare ID - Type Unspecified
LA1676101Medicaid