Provider Demographics
NPI:1639545528
Name:DUBUQUE, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DUBUQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:DUBUQUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:428 KAWAIHAE ST APT 148
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1291
Mailing Address - Country:US
Mailing Address - Phone:808-930-9858
Mailing Address - Fax:808-930-9859
Practice Address - Street 1:428 KAWAIHAE ST APT 148
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1291
Practice Address - Country:US
Practice Address - Phone:808-930-9858
Practice Address - Fax:808-930-9859
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR177803207R00000X
390200000X
HIDOS-1992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program