Most Relevant Information
Provider Data
| NPI Number: | 1003519950 |
| Provider Name: | PETER BRANDON DOMINGUEZ MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/22/2023 |
| Last Updated: | 03/26/2023 |
Provider Practice Location
655 W 8TH ST
JACKSONVILLE
FL
322096511
Practice Location Phone/Fax
| Phone: | 9042444106 |
| Fax: | 9042445848 |
Provider Mailing Location
655 W 8TH ST # C506
JACKSONVILLE
FL
322096511
Provider Mailing Phone/Fax
| Phone: | 9042444106 |
| Fax: | 9042445848 |