Provider Demographics
NPI:1710151618
Name:DUBASH, ROY MINOO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:MINOO
Last Name:DUBASH
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 1:750 MORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9469
Mailing Address - Country:US
Mailing Address - Phone:606-233-1226
Mailing Address - Fax:606-439-1131
Practice Address - Street 1:750 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9469
Practice Address - Country:US
Practice Address - Phone:606-233-1226
Practice Address - Fax:606-439-1131
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1183207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000566868OtherBCBS MARION
OH000000563327OtherBCBS PUTNAM
OH2844024Medicaid
OH2844024Medicaid
OHDU4239512Medicare PIN