MEDICARE: DAVID T. DUBE' P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	925	OK

General Provider Information

NPI Number	:	1578679684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID T. DUBE' P.A.

Provider Business Mailing Address
First Line	:	4401 W MEMORIAL RD
Second Line	:	SUITE #141
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1785
Country	:	US
Telephone Number	:	405-936-5800
Fax Number	:	405-936-5211

Provider Business Practice Location Address
First Line	:	4120 W MEMORIAL RD
Second Line	:	SUITE 108
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9320
Country	:	US
Telephone Number	:	405-936-5648
Fax Number	:	405-936-5661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	05/14/2008

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