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General NPI Number Information
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NPI Number | 1720146954
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Entity Type | Individual
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Provider Name | GREGORY VAN DUBAY DPM
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 875 FRIENDSHIP RD STE J
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City | TALLASSEE
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State | AL
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Zip | 36078-1256
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Country | US
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Telephone | 334-283-4178
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Fax | 334-283-2190
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Provider Business Mailing Address
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Address Line | PO BOX 780367
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City | TALLASSEE
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State | AL
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Zip | 36078-0004
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Country | US
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Telephone | 334-283-4178
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Fax | 334-283-2190
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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 | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | AL71
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License Number State | AL
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