Provider Demographics
NPI:1639110281
Name:DUBOSE, JOSEPH W JR (ARNP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:W
Last Name:DUBOSE
Suffix:JR
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 NW 7TH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1104
Mailing Address - Country:US
Mailing Address - Phone:305-902-6347
Mailing Address - Fax:
Practice Address - Street 1:1951 NW 7TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1104
Practice Address - Country:US
Practice Address - Phone:305-902-6347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007024207P00000X, 363LP0808X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9646712Medicaid
WA0202685OtherLIWA
WA3074DUOtherBSWA
WA0202685OtherLIWA
WA3074DUOtherBSWA