Provider Demographics
NPI:1942389689
Name:DUBA, JOSEPH RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:DUBA
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:PO BOX 8
Mailing Address - Street 2:8 WEST MAIN STREET
Mailing Address - City:SHORTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14548
Mailing Address - Country:US
Mailing Address - Phone:585-289-9160
Mailing Address - Fax:585-289-9162
Practice Address - Street 1:8 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHORTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14548
Practice Address - Country:US
Practice Address - Phone:585-289-9160
Practice Address - Fax:585-289-9162
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1384541208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00941488Medicaid
NY00941488Medicaid
16194BMedicare ID - Type Unspecified