=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235267857
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUBOIS MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2007
-----------------------------------------------------
Last Update Date | 03/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 434 SW 12TH AVE STE 402
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33130-2434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-643-4177
-----------------------------------------------------
Fax | 305-643-0175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 434 SW 12TH AVE STE 402
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33130-2434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-643-4177
-----------------------------------------------------
Fax | 305-643-0175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JORGE DUBOIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-643-4177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------