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General NPI Number Information
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NPI Number | 1871389247
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Entity Type | Individual
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Provider Name | JOE DONALD DZUBAK
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Gender | Male
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 650 JOEL DR
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5318
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Country | US
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Telephone | 270-798-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 7246 WINDING WAY
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City | PLEASANT VIEW
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State | TN
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Zip | 37146-8104
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Country | US
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Telephone | 651-245-5404
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Fax |
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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 | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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