Provider Demographics
NPI:1164414819
Name:DUBOIS, CRAIG DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DANIEL
Last Name:DUBOIS
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 1:124 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5537
Mailing Address - Country:US
Mailing Address - Phone:704-662-3077
Mailing Address - Fax:704-662-3458
Practice Address - Street 1:124 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5537
Practice Address - Country:US
Practice Address - Phone:704-662-3077
Practice Address - Fax:704-662-3458
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94002392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013KPMedicaid
NC2197232Medicare PIN
NCF77673Medicare UPIN