Provider Demographics
NPI:1659319309
Name:DUBNOW, MORTON H (MD)
Entity type:Individual
Prefix:
First Name:MORTON
Middle Name:H
Last Name:DUBNOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6838 N 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1056
Mailing Address - Country:US
Mailing Address - Phone:602-864-8800
Mailing Address - Fax:602-864-1448
Practice Address - Street 1:6838 N 23RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1056
Practice Address - Country:US
Practice Address - Phone:602-864-8800
Practice Address - Fax:602-864-1448
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ229163Medicaid
AZD36780Medicare UPIN
AZ229163Medicaid