Provider Demographics
NPI:1104915115
Name:LAYNES, DOMINADOR VILLANUEVA III (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINADOR
Middle Name:VILLANUEVA
Last Name:LAYNES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3150 HALLMARK CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2173
Mailing Address - Country:US
Mailing Address - Phone:989-497-0011
Mailing Address - Fax:989-497-0444
Practice Address - Street 1:3150 HALLMARK CT
Practice Address - Street 2:STE 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2173
Practice Address - Country:US
Practice Address - Phone:989-497-0011
Practice Address - Fax:989-497-0444
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDL062088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG35525Medicare UPIN
MI0N51850Medicare ID - Type Unspecified