Provider Demographics
NPI:1497125264
Name:BRIAN E DUBOW M D A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BRIAN E DUBOW M D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUBOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-275-8855
Mailing Address - Street 1:435 N ROXBURY DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5027
Mailing Address - Country:US
Mailing Address - Phone:310-275-8855
Mailing Address - Fax:323-848-4290
Practice Address - Street 1:435 N ROXBURY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5027
Practice Address - Country:US
Practice Address - Phone:310-275-8855
Practice Address - Fax:323-848-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty