Provider Demographics
NPI:1972647170
Name:DOMAGALSKI, JASON EREK (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EREK
Last Name:DOMAGALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:555 E TACHEVAH DR STE 2E107
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5752
Mailing Address - Country:US
Mailing Address - Phone:760-561-7373
Mailing Address - Fax:760-770-5893
Practice Address - Street 1:555 E TACHEVAH DR STE 2E107
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5752
Practice Address - Country:US
Practice Address - Phone:760-561-7373
Practice Address - Fax:760-770-5893
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE24005207Q00000X
CAC129763207Q00000X
WI61149-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine