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Jesus David Dominguez

Anesthesiology

Allopathic & Osteopathic Physicians

111 Colchester Ave, Burlington, VT 05401-1473

PECOS Enrollment

This provider is enrolled in PECOS as JESUS DOMINGUEZ.

Based on the most recent information from CMS, provider Jesus David Dominguez is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1023495678
Provider Type
Individual
Full Name
Dominguez, Jesus David
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
5/4/2015
Last Updated
4/1/2022

Contact Information

Practice Location

111 Colchester Ave, Burlington, VT 05401-1473

(802) 847-0000

Unlisted Fax

Mailing Location

1514 Jefferson Hwy, New Orleans, LA 70121-2429

(866) 624-7637

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License 042-0015635 Vermont
Code 207L00000X	Description Anesthesiology Allopathic & Osteopathic Physicians	License 312113 Louisiana

Jesus David Dominguez

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Kirk, Francis Louis

Bull, Michael

Farhang, Borzoo

Aslakson, Rebecca Ann

Stelzer, Shelly R.

Fraser-Harris, Eva V

O'Donnell, Stephen

Mollov, Joshua L

Abnet, Kevin Richard

Danles, Jennifer