Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS8635 | FL |
Y | 207Q00000X | Family Doctor | OS8635 | FL |
NPI | 1275602377 |
---|---|
Provider Name | Donna Dyer Dubois |
First Address | Palm City, FL 34990-8332 |
Second Address | Palm City, FL 34990-8332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 04/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H29352 | (02) | FL |