Provider Demographics
NPI:1841508462
Name:DOMINGUEZ, JEREMY DAVIS (PA-C)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:DAVIS
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4705 BRIARWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2639
Mailing Address - Country:US
Mailing Address - Phone:432-505-4145
Mailing Address - Fax:833-941-0864
Practice Address - Street 1:4705 BRIARWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2639
Practice Address - Country:US
Practice Address - Phone:432-505-4145
Practice Address - Fax:833-941-0864
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06951363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant