Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 39857 | SC |
N | 204F00000X | Transplant Surgeon | 5315008853 | MI |
NPI | 1053584946 |
---|---|
Provider Name | Derek Allen Dubay |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2008 |
Last Update Date | 30/06/2016 |