Healthcare Provider Details

I. General information

NPI: 1104320613
Provider Name (Legal Business Name): JUSTIN JAMES DUBREUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 CAROLINE ST
PORT ANGELES WA
98362-3997
US

IV. Provider business mailing address

PO BOX 24029
SEATTLE WA
98124-0029
US

V. Phone/Fax

Practice location:
  • Phone: 360-417-7000
  • Fax: 360-417-7318
Mailing address:
  • Phone: 360-417-7000
  • Fax: 360-417-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.MD.70089078
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.MD.70089078
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01085616A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: