Provider Demographics
NPI:1386789931
Name:DUBOIS, JEAN CLAUDE (MD)
Entity type:Individual
Prefix:
First Name:JEAN CLAUDE
Middle Name:
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 1:601 E SAMPLE ROAD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:38064
Mailing Address - Country:US
Mailing Address - Phone:954-783-5151
Mailing Address - Fax:954-783-0219
Practice Address - Street 1:601 E SAMPLE ROAD
Practice Address - Street 2:SUITE #110
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:38064
Practice Address - Country:US
Practice Address - Phone:954-783-5151
Practice Address - Fax:954-783-0219
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053632208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
B15929Medicare UPIN
07542AMedicare ID - Type Unspecified