Healthcare Provider Details

I. General information

NPI: 1639373020
Provider Name (Legal Business Name): DUBOIS REGIONAL MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 TURNPIKE AVE
CLEARFIELD PA
16830-1233
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-765-2412
  • Fax:
Mailing address:
  • Phone: 814-375-6566
  • Fax: 814-372-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN S SUTIKA
Title or Position: AUTHORIZED OFFICIAL & SECRETARY
Credential:
Phone: 814-375-3385