Provider Demographics
NPI:1649360512
Name:DOMINGUEZ, DAVID C (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:UNM DEPARTMENT OF EMERGENCY MEDICINE MSC10
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-5062
Practice Address - Fax:505-272-6503
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-09-09
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Provider Licenses
StateLicense IDTaxonomies
NM89-183207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT3-Z8389Medicaid
NC7610976Medicaid
VT1006670Medicaid
MO203890009Medicaid
NMW0103Medicaid
TX051219601Medicaid
MN334049000Medicaid
AZ272378Medicaid
CAXPY184813Medicaid
AZ272378Medicaid