Provider Demographics
NPI:1962426833
Name:DOMB, GEORGE H (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:H
Last Name:DOMB
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 1:2125 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2531
Mailing Address - Country:US
Mailing Address - Phone:530-242-5600
Mailing Address - Fax:530-242-5605
Practice Address - Street 1:2125 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2531
Practice Address - Country:US
Practice Address - Phone:530-242-5600
Practice Address - Fax:530-242-5605
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31077207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G310770Medicaid
CA00G310770Medicaid
CA00G310770Medicare ID - Type Unspecified