Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | S-533-TA-030 | AL |
NPI | 1003975962 |
---|---|
Provider Name | Dr. Wesley A Dubose |
First Address | Tuscaloosa, AL 35404-5874 |
Second Address | Tuscaloosa, AL 35404-5874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2006 |
Last Update Date | 28/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009982770 | (05) | AL |
51507280 | BLUECROSS BLUESHIELD (01) | AL |
T69188 | (02) | AL |