TERRY GAYLE DOMINO MD NPI 1396727988

NPI Information

NPI: 1396727988
Provider Name: TERRY GAYLE DOMINO, MD
Classification: Family Medicine - 207Q00000X
Entity Type: Individual
Address:
1835 WEST COUNTY ROAD C
ROSEVILLE, MN
ZIP 55113
Phone: (763) 785-4300
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Terry Gayle Domino, MD is a family medicine in Roseville, MN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. Terry Gayle Domino, MD NPI is 1396727988. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1835 WEST COUNTY ROAD C
ROSEVILLE, MN
ZIP 55113-304
Phone: (763) 785-4300
Fax: (763) 785-3314

The enumeration date for this NPI number is 11/18/2005 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		22141	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	B52472	MEDICARE UPIN
2	33858500C	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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