Provider Demographics
NPI:1871237834
Name:DUBE, JOHN R
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:DUBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10009 SWEET WILLOW PASS APT 309
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8972
Mailing Address - Country:US
Mailing Address - Phone:507-261-6733
Mailing Address - Fax:
Practice Address - Street 1:601 W DOTY ST APT 421
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2774
Practice Address - Country:US
Practice Address - Phone:507-261-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9625207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine