Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PD1555 | MA |
Y | 222Z00000X | Podiatrist | PD1555 | MA |
NPI | 1033154471 |
---|---|
Provider Name | Raymond J Dubois |
First Address | Easthampton, MA 01027-1081 |
Second Address | Easthampton, MA 01027-1081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 03/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T23499 | (02) | MA |