Healthcare Provider Details

I. General information

NPI: 1396743050
Provider Name (Legal Business Name): JACQUELINE ANN DUBA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DR STE 100
FRISCO CO
80443-5948
US

IV. Provider business mailing address

PO BOX 525
LEADVILLE CO
80461-0525
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-4040
  • Fax:
Mailing address:
  • Phone: 719-838-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0000930
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: