Provider Demographics
NPI:1851384770
Name:DOMINGUEZ, CHRISTOPHER BRITT (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRITT
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8707
Mailing Address - Country:US
Mailing Address - Phone:910-715-5809
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 139
Practice Address - Street 2:SOTF
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28307-5000
Practice Address - Country:US
Practice Address - Phone:910-643-0729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1062273363AM0700X
NC010-05392363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical