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General NPI Number Information
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NPI Number | 1578679684
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Entity Type | Individual
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Provider Name | DAVID T. DUBE' P.A.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 4120 W MEMORIAL RD SUITE 108
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-9320
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Country | US
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Telephone | 405-936-5648
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Fax | 405-936-5661
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Provider Business Mailing Address
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Address Line | 4401 W MEMORIAL RD SUITE #141
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-1785
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Country | US
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Telephone | 405-936-5800
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Fax | 405-936-5211
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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 | 925
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License Number State | OK
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