Provider Demographics
NPI:1386948719
Name:GERET A DU BOIS MD, INC
Entity type:Organization
Organization Name:GERET A DU BOIS MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERET
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DU BOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-723-8300
Mailing Address - Street 1:P.O. BOX L
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-0730
Mailing Address - Country:US
Mailing Address - Phone:401-723-8300
Mailing Address - Fax:401-723-8008
Practice Address - Street 1:330 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-723-8300
Practice Address - Fax:401-723-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI4693207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020415Medicaid
RI9020415Medicaid
209020415Medicare PIN