Provider Demographics
NPI:1669722799
Name:DUBECK, JAMIE LYNNE (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNNE
Last Name:DUBECK
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Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:5501 MARVIN SHIELDS BLVD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-9007
Mailing Address - Country:US
Mailing Address - Phone:228-822-5792
Mailing Address - Fax:228-871-2135
Practice Address - Street 1:5501 MARVIN SHIELDS BLVD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-9007
Practice Address - Country:US
Practice Address - Phone:228-822-5792
Practice Address - Fax:228-871-2135
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant