Healthcare Provider Details

I. General information

NPI: 1588669782
Provider Name (Legal Business Name): DONALD A DUBOIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 MAIN ST
SKOWHEGAN ME
04976-1146
US

IV. Provider business mailing address

PO BOX 468
SKOWHEGAN ME
04976-0468
US

V. Phone/Fax

Practice location:
  • Phone: 207-858-4844
  • Fax: 207-858-0348
Mailing address:
  • Phone: 207-858-8353
  • Fax: 207-474-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number013036
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number013036
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: