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General NPI Number Information
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NPI Number | 1639373020
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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 | 06/12/2007
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 820 TURNPIKE AVE
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City | CLEARFIELD
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State | PA
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Zip | 16830-1233
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Country | US
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Telephone | 814-765-2412
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Fax |
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Provider Business Mailing Address
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Address Line | 100 HOSPITAL AVE
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City | DU BOIS
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State | PA
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Zip | 15801-1440
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Country | US
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Telephone | 814-375-6566
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Fax | 814-372-2848
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL & SECRETARY
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Name | MR. JOHN S SUTIKA
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Credential |
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Telephone | 814-375-3385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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