Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 23784 | NE |
NPI | 1033285200 |
---|---|
Provider Name | Dr. Matthew Ray Doubrava |
First Address | Wright Patterson Afb, OH 45433-5529 |
Second Address | Wright Patterson Afb, OH 45433-5529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 28/01/2020 |