Provider Demographics
NPI:1679525406
Name:DUBOSE, JOHN B III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:DUBOSE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1259
Mailing Address - Street 2:SENTINEL HEALTH PARTNERS PA BUSINESS OFFICE
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021-1259
Mailing Address - Country:US
Mailing Address - Phone:803-713-8350
Mailing Address - Fax:803-713-8433
Practice Address - Street 1:1344 HAILE ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3076
Practice Address - Country:US
Practice Address - Phone:803-432-1996
Practice Address - Fax:803-424-2703
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-02-24
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Provider Licenses
StateLicense IDTaxonomies
SC7301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC073011Medicaid
SC110143743OtherRAILROAD MEDICARE PIN
23196OtherMEDCOST
23196OtherMEDCOST
SCC609435378Medicare PIN