Provider Demographics
NPI:1164746095
Name:RICHARD H DUBOU MD PSC
Entity Type:Organization
Organization Name:RICHARD H DUBOU MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:DUBOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-933-1100
Mailing Address - Street 1:9702 STONESTREET RD
Mailing Address - Street 2:304
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2860
Mailing Address - Country:US
Mailing Address - Phone:502-933-1100
Mailing Address - Fax:502-933-1153
Practice Address - Street 1:9702 STONESTREET RD
Practice Address - Street 2:304
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2860
Practice Address - Country:US
Practice Address - Phone:502-933-1100
Practice Address - Fax:502-933-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065446A2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201042870AMedicaid
KY7100188340Medicaid
KY7100188340Medicaid
IN266770Medicare PIN
INDR0336Medicare PIN