Healthcare Provider Details

I. General information

NPI: 1265560049
Provider Name (Legal Business Name): GEORGE BRIAN DUEBER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 N. MONTESANO
WESTPORT WA
98595
US

IV. Provider business mailing address

723 N. MONTESANO PO BOX 2229
WESTPORT WA
98595
US

V. Phone/Fax

Practice location:
  • Phone: 360-268-0195
  • Fax: 360-268-1442
Mailing address:
  • Phone: 360-268-0195
  • Fax: 360-268-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8497
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOP00001786
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: