Provider Demographics
NPI:1114075280
Name:DUBY, ALLAN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:DAVID
Last Name:DUBY
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 1:16106 SHADYBANK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2961
Mailing Address - Country:US
Mailing Address - Phone:972-239-2301
Mailing Address - Fax:
Practice Address - Street 1:16106 SHADYBANK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-2961
Practice Address - Country:US
Practice Address - Phone:972-239-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2113207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15406Medicare UPIN
TX88Z840Medicare PIN