Gagne, Dominique
Gagne, Dominique is an individual health care provider with primary practice located at 111 E Dunlap Ave Ste 1-482 , Phoenix AZ 85020-7806. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is her primary health care specialty. Gagne, Dominique can be contacted via phone (602) 609-2600.Contact Information
Primary practice address
111 E Dunlap Ave Ste 1-482
Phoenix AZ 85020-7806
Phone: (602) 609-2600
Fax: (602) 609-2601
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | 50171 | Arizona |
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | 50171 | Arizona |
Profile Details
| NPI number | 1528418696 |
|---|---|
| LBN Legal business name | Gagne, Dominique |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 20th, 2016 |
| Last updated | Oct 14th, 2020 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528418696 | NPPES |
| Arizona | Other | Z246972 | MEDICARE PTAN |
| Arizona | MEDICAID | 204096 | MEDICARE PTAN |
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