Provider Demographics
NPI:1093991432
Name:RAYMOND J DUBOIS, DPM
Entity Type:Organization
Organization Name:RAYMOND J DUBOIS, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:413-529-9654
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPD-1555335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4840700001Medicare NSC
MAT23499Medicare UPIN
MADUY70652Medicare PIN