Provider Demographics
NPI:1699702035
Name:DOMAN, FLORENCE FAYE (MD)
Entity type:Individual
Prefix:DR
First Name:FLORENCE
Middle Name:FAYE
Last Name:DOMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 JUSTENE CIR
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-7568
Mailing Address - Country:US
Mailing Address - Phone:417-839-5755
Mailing Address - Fax:
Practice Address - Street 1:LEHIGH REGIONAL MEDICAL CENTER
Practice Address - Street 2:1500 LEE BLVD.
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936
Practice Address - Country:US
Practice Address - Phone:239-303-2600
Practice Address - Fax:239-303-2604
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004022322207R00000X
MO2012033551208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201112080Medicaid
KY7100510910Medicaid
MO209315605Medicaid
IN201112080Medicaid
MO209315605Medicaid