Provider Demographics
NPI:1427013580
Name:DUBOIS, GUSTAVO A (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:A
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 1:2018 BROOKWOOD MEDICAL CENTER DR
Mailing Address - Street 2:STE 115
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-802-6186
Mailing Address - Fax:205-802-3941
Practice Address - Street 1:2018 BROOKWOOD MEDICAL CENTER DR
Practice Address - Street 2:STE 115
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-802-6186
Practice Address - Fax:205-802-3941
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL10246207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000034307Medicaid
AL000034306Medicaid
AL000034307Medicaid
AL000034307Medicare PIN
C75968Medicare UPIN