Healthcare Provider Details

I. General information

NPI: 1740205046
Provider Name (Legal Business Name): JOHN CHARLES DUBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

725 UNIVERSITY BLVD
BEAVERCREEK OH
45324-2640
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8050
  • Fax: 330-543-8054
Mailing address:
  • Phone: 937-245-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.059883
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number35-059883
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: