Provider Demographics
NPI:1912987918
Name:DUBUISSON, JULIE T (PA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:T
Last Name:DUBUISSON
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD STE 200
Mailing Address - Street 2:(ATTN) FORSYTH MEDICAL GROUP
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-277-2435
Mailing Address - Fax:336-277-9275
Practice Address - Street 1:105 VEST MILL CIR
Practice Address - Street 2:DBA SALEM FAMILY PRACTICE
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2943
Practice Address - Country:US
Practice Address - Phone:336-718-7800
Practice Address - Fax:336-718-7900
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC00604363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS63550Medicare UPIN
NC2799261Medicare ID - Type Unspecified