Healthcare Provider Details

I. General information

NPI: 1316953094
Provider Name (Legal Business Name): DON R DUBOIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E COUNTY LINE RD SUITE B
GREENWOOD IN
46143-1046
US

IV. Provider business mailing address

396 LEISURE LN
GREENWOOD IN
46142-8529
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-6333
  • Fax: 317-497-6334
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01020429A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: