Provider Demographics
NPI:1043203292
Name:DUBIN, SOL H (MD)
Entity Type:Individual
Prefix:DR
First Name:SOL
Middle Name:H
Last Name:DUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 E 39TH ST S
Mailing Address - Street 2:SUITE 400
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2303
Mailing Address - Country:US
Mailing Address - Phone:816-254-4800
Mailing Address - Fax:816-254-4641
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 400
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:816-254-4800
Practice Address - Fax:816-254-4641
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200256907Medicaid
MS1043203292Medicaid
MOC51462Medicare UPIN
MO200256907Medicaid