Provider Demographics
NPI:1891064127
Name:DOMBEK, STANLEY JOSEPH JR (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:JOSEPH
Last Name:DOMBEK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13900 N. PORTLAND AVE.
Mailing Address - Street 2:ADVANCED BODY IMAGING, LLC.
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-4042
Mailing Address - Country:US
Mailing Address - Phone:405-242-1390
Mailing Address - Fax:405-242-1400
Practice Address - Street 1:13900 N. PORTLAND AVE. SUITE 100
Practice Address - Street 2:ADVANCCED BODY SCAN
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-4042
Practice Address - Country:US
Practice Address - Phone:405-242-1390
Practice Address - Fax:405-242-1400
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK9647208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)