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General NPI Number Information
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NPI Number | 1598970949
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Entity Type | Organization
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Legal Business Name | DUBOIS REGIONAL MEDICAL GROUP, PC
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 807 DOCTORS DR
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City | CLEARFIELD
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State | PA
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Zip | 16830-1240
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Country | US
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Telephone | 814-375-3711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 189
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City | REYNOLDSVILLE
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State | PA
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Zip | 15851-0189
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Country | US
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Telephone | 814-653-8162
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT & CFO
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Name | JOHN S SUTIKA
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Credential |
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Telephone | 814-375-6104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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