Provider Demographics
NPI:1578679684
Name:DUBE', DAVID T (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:DUBE'
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE #141
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-936-5800
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:4120 W MEMORIAL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9320
Practice Address - Country:US
Practice Address - Phone:405-936-5648
Practice Address - Fax:405-936-5661
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-05-14
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Provider Licenses
StateLicense IDTaxonomies
OK925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS62668Medicare UPIN