Provider Demographics
NPI:1306066790
Name:DOMINGUEZ-CESPEDES, JAIME DAVID (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:DAVID
Last Name:DOMINGUEZ-CESPEDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 10TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1376
Mailing Address - Country:US
Mailing Address - Phone:509-787-3531
Mailing Address - Fax:509-787-2016
Practice Address - Street 1:908 10TH AVE SW
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1376
Practice Address - Country:US
Practice Address - Phone:509-787-3531
Practice Address - Fax:509-787-2016
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00049366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8517237Medicaid
WA8947901OtherCV
WA237692OtherLABOR & INDUSTRIES
WA237692OtherL&I
WA8947901OtherCV