Healthcare Provider Details

I. General information

NPI: 1316923337
Provider Name (Legal Business Name): DAVID R DUBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S SHERMAN ST SUITE 201
SPOKANE WA
99202-1342
US

IV. Provider business mailing address

610 S SHERMAN ST SUITE 201
SPOKANE WA
99202-1342
US

V. Phone/Fax

Practice location:
  • Phone: 509-458-7720
  • Fax: 509-777-0432
Mailing address:
  • Phone: 509-458-7720
  • Fax: 509-777-0432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number00031219
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: