Provider Demographics
NPI:1033154471
Name:DUBOIS, RAYMOND J (DPM)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:J
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1081
Mailing Address - Country:US
Mailing Address - Phone:413-529-9654
Mailing Address - Fax:413-282-0011
Practice Address - Street 1:126 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1081
Practice Address - Country:US
Practice Address - Phone:413-529-9654
Practice Address - Fax:413-282-0011
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPD1555213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADUY70652Medicare PIN
MAT23499Medicare UPIN
MA4840700001Medicare NSC