MEDICARE: MR. DAVID ALLAN DUBOIS MASTERS OF ARTS

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
1	103T00000X	Psychologist
2	103T00000X	Psychologist	LP2840	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004399432	OTHER	MN	AETNA INS. CO.
2	2347539-00	OTHER	MN	MINNESOTA CARE
3	123475	OTHER	MN	BEHAVIORALHEALTHCAREPROVI
4	030822002	OTHER	MN	METROPLIITANHEALTHPLAN
5	57332-DU	OTHER	MN	BLUECROSS/BLUESHIELD MN
6	6276558	OTHER	MN	UNITEDBEHAVIORALHEALTH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720084502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ALLAN DUBOIS MASTERS OF ARTS

Provider Business Mailing Address
First Line	:	3332 21ST AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2412
Country	:	US
Telephone Number	:	612-296-9444
Fax Number	:

Provider Business Practice Location Address
First Line	:	3332 21ST AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2412
Country	:	US
Telephone Number	:	612-296-9444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2005
Last Update Date	:	10/21/2022

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