Provider Demographics
NPI:1316953094
Name:DUBOIS, DON R (MD)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:R
Last Name:DUBOIS
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 1:396 LEISURE LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-8529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 E COUNTY LINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1046
Practice Address - Country:US
Practice Address - Phone:317-497-6333
Practice Address - Fax:317-497-6334
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020429A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000312862OtherANTHEM
IN100047940Medicaid
IN000000680942OtherANTHEM
IN000000312862OtherANTHEM
IN000000680942OtherANTHEM