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General NPI Number Information
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NPI Number | 1316456965
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Entity Type | Organization
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Legal Business Name | ANTON DUBRICK MD SC
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Dates
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Enumeration Date | 09/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 420 W SCHWARTZ ST
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City | SALEM
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State | IL
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Zip | 62881-1552
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Country | US
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Telephone | 618-740-4667
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Fax | 618-740-1482
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Provider Business Mailing Address
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Address Line | 420 W SCHWARTZ ST
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City | SALEM
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State | IL
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Zip | 62881-1552
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Country | US
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Telephone | 618-740-4667
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Fax | 618-740-1482
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTON DUBRICK
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Credential | MD
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Telephone | 618-740-4667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036061031
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License Number State | IL
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