Provider Demographics
NPI:1336370527
Name:DOMINY, DONALD DEAN III (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DEAN
Last Name:DOMINY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4728
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:
Practice Address - Street 1:16811 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4728
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1615207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307642401Medicaid
TX307642403Medicaid
TX307642402Medicaid
TX307642406Medicaid
TX1336370527OtherBLUE CROSS BLUE SHIELD
TXP01170515OtherRR MEDICARE
TX307642405Medicaid
TX307642404Medicaid
TXP01258412OtherMEDICARE RR
TXP01258412OtherMEDICARE RR
TX307642405Medicaid
TX298866YQ64Medicare PIN
TXTXB160291Medicare PIN