Provider Demographics
NPI:1568485043
Name:DUBRICK, ANTON JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:JOHN
Last Name:DUBRICK
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 1:420 W SCHWARTZ ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-1552
Mailing Address - Country:US
Mailing Address - Phone:618-740-4667
Mailing Address - Fax:618-740-1482
Practice Address - Street 1:420 W SCHWARTZ ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1552
Practice Address - Country:US
Practice Address - Phone:618-740-4667
Practice Address - Fax:618-740-1482
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-061031207QA0505X, 209800000X
IL036061031207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine