Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 00025299 | AL |
Y | 207PP0204X | Pediatric Emergency Physician | TEMP | TX |
NPI | 1497742647 |
---|---|
Provider Name | Dr. Dale D Dubois |
First Address | San Antonio, TX 78229-5900 |
Second Address | San Antonio, TX 78229-5900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 11/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009920935 | (05) | AL |
051516166 | BCBS PROVIDER NUMBER (01) | AL |
I04337 | (02) | AL |
PENDING | (05) | TX |
PENDING | BCBS (01) | TX |