Provider Demographics
NPI:1184990731
Name:IGOE, DOMINIQUE (PA-C)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:IGOE
Suffix:
Gender:F
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:PO BOX 40065
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-0065
Mailing Address - Country:US
Mailing Address - Phone:720-580-8001
Mailing Address - Fax:720-580-8001
Practice Address - Street 1:2802 MADISON SQUARE DR
Practice Address - Street 2:100
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3396
Practice Address - Country:US
Practice Address - Phone:970-221-9451
Practice Address - Fax:970-416-9676
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3369363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical