Provider Demographics
NPI:1386778348
Name:DUBIN, ALAN LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LESLIE
Last Name:DUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 KELLER ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2939
Mailing Address - Country:US
Mailing Address - Phone:707-769-1220
Mailing Address - Fax:707-769-1220
Practice Address - Street 1:14 KELLER ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2939
Practice Address - Country:US
Practice Address - Phone:707-769-1220
Practice Address - Fax:707-769-1220
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC369942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36437Medicare UPIN
CAA36437Medicare UPIN