Individual provider · Type 1 NPI

Michael William Dominisse Jr., PA

Physician Assistant · Fort Worth, TX

NPI number 1962914580 Active

Practice location

5751 Edwards Ranch Rd Ste 101
Fort Worth, TX 76109-4131

Call (817) 923-8220 Map

Mailing address

210 Canyon Creek Cir, Canyon Creek Circle
Weatherford, TX 76087-4039

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant Primary 363A00000XNone listed

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1962914580

Michael William Dominisse Jr., PA's National Provider Identifier is 1962914580, issued on Nov 5, 2017. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Fort Worth, TX. The record was last updated on Feb 23, 2026.