Provider Demographics
NPI:1104049592
Name:DOMINGUEZ, TAMARA JEANNE (MD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:JEANNE
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2 LINDQUIST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-2448
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4800 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 127
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3628
Practice Address - Country:US
Practice Address - Phone:210-468-0800
Practice Address - Fax:210-733-8649
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG50539Medicare UPIN