Healthcare Provider Details

I. General information

NPI: 1114056421
Provider Name (Legal Business Name): KEVIN JOSEPH DUBREE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST, NW UNIT 1F, ROOM 1218
WASHINGTON DC
20010-2927
US

IV. Provider business mailing address

835 RANDOLPH DR
ABERDEEN MD
21001-1239
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-8115
  • Fax:
Mailing address:
  • Phone: 202-877-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA30060
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: