Provider Demographics
NPI:1063402386
Name:DUBBERLY, DANNY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:LEE
Last Name:DUBBERLY
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 1:3301 S ALAMEDA STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1889
Mailing Address - Country:US
Mailing Address - Phone:361-225-0800
Mailing Address - Fax:361-855-7094
Practice Address - Street 1:3301 S ALAMEDA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1882
Practice Address - Country:US
Practice Address - Phone:361-225-0800
Practice Address - Fax:361-225-2200
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00318493OtherRAILROAD MEDICARE
TX8F1975OtherBLUE CROSS BLUE SHIELD
TX140389162Medicaid
TX8D7444Medicare PIN
TX140389162Medicaid