Provider Demographics
NPI:1972808103
Name:DUBE, MARIO (DOM)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:DUBE
Suffix:
Gender:M
Credentials:DOM
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Mailing Address - Street 1:9114 TOWN CENTER PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5054
Mailing Address - Country:US
Mailing Address - Phone:941-351-4949
Mailing Address - Fax:941-351-3033
Practice Address - Street 1:9114 TOWN CENTER PKWY
Practice Address - Street 2:STE 101
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5054
Practice Address - Country:US
Practice Address - Phone:941-351-4949
Practice Address - Fax:941-351-3033
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2015-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAP 2931171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist