Provider Demographics
NPI:1902204860
Name:RICHARD A DUBE
Entity Type:Organization
Organization Name:RICHARD A DUBE
Other - Org Name:RICHARD A DUBE MD SNFS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-223-0983
Mailing Address - Street 1:7 COUNTRY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2006
Mailing Address - Country:US
Mailing Address - Phone:772-631-6265
Mailing Address - Fax:
Practice Address - Street 1:1500 SE PALM BEACH RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4044
Practice Address - Country:US
Practice Address - Phone:772-631-6265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36471208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0669601Medicaid
FL0669601Medicaid