Provider Demographics
NPI:1164437471
Name:DUBOSE, DANIEL THOMAS (MD FACS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:THOMAS
Last Name:DUBOSE
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 MORNING STAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:209-533-2545
Mailing Address - Fax:209-533-0924
Practice Address - Street 1:795 MORNING STAR DRIVE
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-533-2545
Practice Address - Fax:209-533-0924
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG670890207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA040011285OtherRAILROAD RETIREMENT
CA00G670890Medicaid
CA040011285OtherRAILROAD RETIREMENT
CAG33514Medicare UPIN