Provider Demographics
NPI:1902332745
Name:CRAIN, DOMINIQUE' JUANITA (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE'
Middle Name:JUANITA
Last Name:CRAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36258
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-1204
Mailing Address - Country:US
Mailing Address - Phone:251-318-2678
Mailing Address - Fax:251-405-9900
Practice Address - Street 1:6801 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3709
Practice Address - Country:US
Practice Address - Phone:251-266-3580
Practice Address - Fax:251-266-3581
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD.22423207Q00000X
GA85140207Q00000X
CAA175163207Q00000X
ALMD.38149208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine