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General NPI Number Information
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NPI Number | 1467725630
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Entity Type | Individual
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Provider Name | GWENDOLYN MARIE DUBOSE P.A.
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Gender | Female
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Dates
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Enumeration Date | 02/17/2012
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 114 W BUFFINGTON AVE STE B
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City | ANDERSON
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State | TX
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Zip | 77830-4979
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Country | US
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Telephone | 936-261-7768
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Fax | 936-249-9932
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Provider Business Mailing Address
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Address Line | 114 W BUFFINGTON AVE STE B
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City | ANDERSON
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State | TX
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Zip | 77830-4979
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Country | US
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Telephone | 936-261-7768
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Fax | 936-249-9932
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA05851
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License Number State | TX
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