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NPI Code Detail

MEDICARE: DAVID T. DUBE' P.A.

MEDICARE: DAVID T. DUBE' P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant925OK

General Provider Information

NPI Number : 1578679684
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID T. DUBE' P.A.
Provider Business Mailing Address
First Line : 15112 TRADITIONS BLVD STE A
Second Line :
City : EDMOND
State : OK
Zip : 73013-1182
Country : US
Telephone Number : 405-289-0483
Fax Number : 405-266-6609
Provider Business Practice Location Address
First Line : 15112 TRADITIONS BLVD STE A
Second Line :
City : EDMOND
State : OK
Zip : 73013-1182
Country : US
Telephone Number : 405-289-0483
Fax Number : 405-266-6609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 04/14/2026

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