Provider Demographics
NPI:1417161258
Name:DUBOSE, BARRY DAVID (CNIM)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:DAVID
Last Name:DUBOSE
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 CALDER ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1952
Mailing Address - Country:US
Mailing Address - Phone:409-749-0200
Mailing Address - Fax:
Practice Address - Street 1:2626 CALDER ST
Practice Address - Street 2:STE. 101
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1952
Practice Address - Country:US
Practice Address - Phone:409-749-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic