Provider Demographics
NPI:1316923337
Name:DUBA, DAVID R (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:DUBA
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 1:610 S SHERMAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1342
Mailing Address - Country:US
Mailing Address - Phone:509-458-7720
Mailing Address - Fax:509-777-0432
Practice Address - Street 1:610 S SHERMAN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1342
Practice Address - Country:US
Practice Address - Phone:509-458-7720
Practice Address - Fax:509-777-0432
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00031219208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1084276Medicaid
WA1084276Medicaid
WAE48263Medicare UPIN
WA000304863Medicare PIN