Healthcare Provider Details

I. General information

NPI: 1043908007
Provider Name (Legal Business Name): ISAAC PAUL DZUBAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2595
US

IV. Provider business mailing address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-3456
  • Fax:
Mailing address:
  • Phone: 651-254-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number80464
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: