Provider Demographics
NPI:1932185121
Name:DUBE, MICHAEL N (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:DUBE
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 1:501 E WATAUGA AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4038
Mailing Address - Country:US
Mailing Address - Phone:423-722-8446
Mailing Address - Fax:423-722-5674
Practice Address - Street 1:501 E WATAUGA AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4038
Practice Address - Country:US
Practice Address - Phone:423-722-8446
Practice Address - Fax:423-722-5674
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 27864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373600Medicare ID - Type Unspecified
G30848Medicare UPIN