Provider Demographics
NPI:1588669782
Name:DUBOIS, DONALD A (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:DUBOIS
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:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-858-8353
Mailing Address - Fax:207-474-9261
Practice Address - Street 1:62 MAIN ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1146
Practice Address - Country:US
Practice Address - Phone:207-858-4844
Practice Address - Fax:207-858-0348
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013036208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010538586OtherHARVARD PILGRIM
ME252370099Medicaid
ME2386238OtherAETNA
ME027630OtherANTHEM BCBS
ME010538586OtherMEDNET
MEM61971COtherCIGNA
ME252370099Medicaid
ME010538586OtherMEDNET