Provider Demographics
NPI:1821554841
Name:DUBAY, DAVID RAYMOND
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RAYMOND
Last Name:DUBAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S BEACH ST APT 151
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-6278
Mailing Address - Country:US
Mailing Address - Phone:386-222-6583
Mailing Address - Fax:
Practice Address - Street 1:1025 S BEACH ST APT 151
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-6278
Practice Address - Country:US
Practice Address - Phone:386-222-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD100176791620343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)