Anthony M Dominic Sr DO PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1833 Issued in AZ

Legal business name

ANTHONY M DOMINIC SR DO PC

Practice address

850 S Ironwood Dr
Ste 104
Apache Junction, AZ 85220-6242

Phone

(480) 982-1265

Fax

(480) 982-8831

NPI assigned

Jul 12, 2005

Last updated

Jan 14, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Anthony M Dominic Sr., DO

Title

President

Phone

(480) 982-1265

Specialties & licenses 2

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1922006204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 S IRONWOOD DR",
            "address_2": "STE 104",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "852206242",
            "telephone_number": "480-982-1265",
            "fax_number": "480-982-8831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 S IRONWOOD DR",
            "address_2": "STE 104",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "852206242",
            "telephone_number": "480-982-1265",
            "fax_number": "480-982-8831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHONY M DOMINIC SR DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "DOMINIC",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-982-1265",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "1833",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34002451",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "1Z0948",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0390340",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160127",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.