Healthcare Provider Details

I. General information

NPI: 1669900379
Provider Name (Legal Business Name): JOSEPH CAMERON DUBERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 HOUMA BLVD STE 300
METAIRIE LA
70006-4203
US

IV. Provider business mailing address

3530 HOUMA BLVD STE 300
METAIRIE LA
70006-4203
US

V. Phone/Fax

Practice location:
  • Phone: 504-264-5142
  • Fax: 504-455-2648
Mailing address:
  • Phone: 504-264-5142
  • Fax: 504-455-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCOVID19-TMP-621
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number326245
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: