Provider Demographics
NPI:1750413753
Name:DRS DUBOIS & DUBOIS LTD
Entity type:Organization
Organization Name:DRS DUBOIS & DUBOIS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-766-6700
Mailing Address - Street 1:501 GREAT ROAD
Mailing Address - Street 2:UNIT 102
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896
Mailing Address - Country:US
Mailing Address - Phone:401-766-6700
Mailing Address - Fax:401-765-7782
Practice Address - Street 1:501 GREAT ROAD
Practice Address - Street 2:UNIT 102
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896
Practice Address - Country:US
Practice Address - Phone:401-766-6700
Practice Address - Fax:401-765-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RID0308207Q00000X
RID0428207Q00000X
RID0307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA1452OtherPILGRIM
0100126OtherUNITED HEALTH
404314OtherTUFTS
404336OtherTUFTS
AA1431OtherPILGRIM
0100305OtherUNITED HEALTH
203892OtherBLUE CHIP
RI30726OtherBLUE CROSS
404318OtherTUFTS
0100127OtherUNITED HEALTH
AA1430OtherPILGRIM
000686OtherBLUE CHIP
004921OtherBLUE CHIP
0100305OtherUNITED HEALTH
AA1452OtherPILGRIM
404318OtherTUFTS
RI089003072Medicare ID - Type Unspecified