Provider Demographics
NPI:1477531101
Name:DUBOSE, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DUBOSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 TERMINAL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-6005
Mailing Address - Country:US
Mailing Address - Phone:713-344-0901
Mailing Address - Fax:713-344-1298
Practice Address - Street 1:4950 TERMINAL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-6013
Practice Address - Country:US
Practice Address - Phone:713-344-0901
Practice Address - Fax:713-344-1298
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5527680001Medicare NSC