Provider Demographics
NPI:1720146954
Name:DUBAY, GREGORY VAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:VAN
Last Name:DUBAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:CENTRAL ALABAMA FOOT
Other - Middle Name:CARE,
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 780367
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-0004
Mailing Address - Country:US
Mailing Address - Phone:334-283-4178
Mailing Address - Fax:334-283-2190
Practice Address - Street 1:875 FRIENDSHIP RD STE J
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1256
Practice Address - Country:US
Practice Address - Phone:334-283-4178
Practice Address - Fax:334-283-2190
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL71213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1841468238OtherGROUP NPI
AL051552056Medicaid
AL515-12528OtherBCBSAL
AL051552056OtherMEDICARE PROVIDER
AL515-12528OtherBCBSAL
ALT68871Medicare UPIN