Provider Demographics
NPI:1801240577
Name:VANBEEST, DOMINQUE (MD)
Entity type:Individual
Prefix:
First Name:DOMINQUE
Middle Name:
Last Name:VANBEEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:
Other - Last Name:VAN BEEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2637 N 400 E STE 164
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2240
Mailing Address - Country:US
Mailing Address - Phone:214-970-6817
Mailing Address - Fax:
Practice Address - Street 1:3600 S LOOP 340
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:TX
Practice Address - Zip Code:76706-4828
Practice Address - Country:US
Practice Address - Phone:254-523-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
TX390200000X
TXU7072208100000X
WAMD.MD.611762562081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Single Specialty