Provider Demographics
NPI:1730709072
Name:DUBOSE, TASHA D
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:D
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 NE 10TH ST STE A106
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3600
Mailing Address - Country:US
Mailing Address - Phone:405-731-9012
Mailing Address - Fax:888-875-1829
Practice Address - Street 1:7901 NE 10TH ST STE A106
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3600
Practice Address - Country:US
Practice Address - Phone:405-731-9012
Practice Address - Fax:888-875-1829
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management