Provider Demographics
NPI:1538264205
Name:DUBOIS, JOHN J (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 THE LEGENDS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025
Mailing Address - Country:US
Mailing Address - Phone:636-549-0121
Mailing Address - Fax:636-549-0122
Practice Address - Street 1:20 THE LEGENDS PKWY
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3801
Practice Address - Country:US
Practice Address - Phone:636-549-0121
Practice Address - Fax:636-549-0122
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002004657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245859301Medicaid
MOH59979Medicare UPIN
MO152800128Medicare PIN
MO000014219Medicare ID - Type Unspecified