Healthcare Provider Details

I. General information

NPI: 1184645681
Provider Name (Legal Business Name): STEPHEN PAUL DUBOS II DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GYPSY LN
YOUNGSTOWN OH
44504-1315
US

IV. Provider business mailing address

7871 WALNUT ST # B
BOARDMAN OH
44512-7729
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number34003659D
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: