DR. JEROME TAYMON DOMZALSKI MD NPI 1952539280

NPI Information

NPI: 1952539280
Provider Name: DR. JEROME TAYMON DOMZALSKI, MD
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

PECOS Registration: Yes

Address:
530 NE GLEN OAK AVE
PEORIA, IL
ZIP 61637
Phone: (309) 655-2000
Get Directions

DR. Jerome Taymon Domzalski, MD is a diagnostic radiology radiology in Peoria, IL with 15 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. DR. Jerome Taymon Domzalski, MD NPI is 1952539280. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: DUKE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2009

The provider's business location address is:

530 NE GLEN OAK AVE
PEORIA, IL
ZIP 61637-748
Phone: (309) 655-2000

The NPI 1952539280 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/25/2009 and was last updated on 10/23/2023.

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	2085R0202X	Radiology	Diagnostic Radiology	MD185931	OREGON	No
2	2085R0202X	Radiology	Diagnostic Radiology	MD60808674	WASHINGTON	No
3	2085R0202X	Radiology	Diagnostic Radiology	M-14669	IDAHO	No
4	2085R0202X	Radiology	Diagnostic Radiology	036-164444	ILLINOIS	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	0384868	OTHER	WASHINGTON	LNI TRA-MINW, PS REST OF WA COUNTIES
2	0384886	OTHER	WASHINGTON	LNI DINW
3	0408166	OTHER	WASHINGTON	LNI RADIA REST OF WA
4	0384879	OTHER	WASHINGTON	LNI TRA-MINW, PS KING COUNTY
5	0408173	OTHER	WASHINGTON	LNI EVERGREEN RADIA
6	2094399	MEDICAID	WASHINGTON
7	0384883	OTHER	WASHINGTON	LNI UAOM
8	0408171	OTHER	WASHINGTON	LNI SWEDISH RADIA EDMONDS
9	0408174	OTHER	WASHINGTON	LNI SOUTH SOUND RADIOLOGY
10	0408176	OTHER	WASHINGTON	LNI SEATTLE RADIOLOGY
11	0408168	OTHER	WASHINGTON	LNI RADIA KING COUNTY

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: 4/28/2024

NPI Synchronization or Removal

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