Provider Demographics
NPI:1497742647
Name:DUBOIS, DALE D (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:D
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8401 DATAPOINT DR
Mailing Address - Street 2:STE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5900
Mailing Address - Country:US
Mailing Address - Phone:210-614-0180
Mailing Address - Fax:210-566-5698
Practice Address - Street 1:8401 DATAPOINT DR
Practice Address - Street 2:STE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5900
Practice Address - Country:US
Practice Address - Phone:210-614-0180
Practice Address - Fax:210-566-5698
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2011-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL00025299207P00000X
TXTEMP207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
AL051516166OtherBCBS PROVIDER NUMBER
AL009920935Medicaid
TXPENDINGOtherBCBS
AL009920935Medicaid
TXPENDINGMedicare PIN