Provider Demographics
NPI:1689643082
Name:DUBRAY, LAWRENCE JAMES SR (PA)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:JAMES
Last Name:DUBRAY
Suffix:SR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO #152
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:SD
Mailing Address - Zip Code:57555
Mailing Address - Country:US
Mailing Address - Phone:605-747-4077
Mailing Address - Fax:
Practice Address - Street 1:SOUTH SOLDIER CREEK RD HOSPITAL
Practice Address - Street 2:
Practice Address - City:ROSEBUD PHS IHS
Practice Address - State:SD
Practice Address - Zip Code:57570
Practice Address - Country:US
Practice Address - Phone:605-747-2231
Practice Address - Fax:605-747-5352
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD0102363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P33220Medicare UPIN