Provider Demographics
NPI:1518017615
Name:DUBUC, SERGE (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGE
Middle Name:
Last Name:DUBUC
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 1:3245 RIDGECANE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1122
Mailing Address - Country:US
Mailing Address - Phone:859-219-2409
Mailing Address - Fax:
Practice Address - Street 1:1001 CHERRY BLOSSOM WAY
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9564
Practice Address - Country:US
Practice Address - Phone:502-868-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36336261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH65579Medicare UPIN