Provider Demographics
NPI:1699779645
Name:DOMINGUE, JAMES NEAL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:NEAL
Last Name:DOMINGUE
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 1:1245 S COLLEGE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2907
Mailing Address - Country:US
Mailing Address - Phone:337-269-5840
Mailing Address - Fax:337-237-7568
Practice Address - Street 1:1245 S COLLEGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2907
Practice Address - Country:US
Practice Address - Phone:337-269-5840
Practice Address - Fax:337-237-7568
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0127022084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1190497Medicaid
51552Medicare ID - Type Unspecified
LA1190497Medicaid