Domino, Terry Gayle

Domino, Terry Gayle is an individual health care provider with primary practice located at 1835 West County Road C , Roseville MN 55113-1304. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Domino, Terry Gayle can be contacted via phone (763) 785-4300.

Contact Information

Primary practice address
1835 West County Road C Roseville MN 55113-1304
Phone: (763) 785-4300
Fax: (763) 785-3314
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 22141 Minnesota

Profile Details

NPI number 1396727988
LBN Legal business name Domino, Terry Gayle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 18th, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396727988 NPPES
Minnesota MEDICAID 33858500C

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