# DUBOIS MEDICAL CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104819762
- **Authorized official:** PEGGY CULVER DUBOIS MD (OWNER)
- **Authorized official phone:** (405) 741-8686

## Contact information

- **Practice address:** 1117 S DOUGLAS BLVD, STE D, MIDWEST CITY, OK 73130-5262
- **Practice address phone:** (405) 741-8686
- **Practice address fax:** (405) 733-9621
- **Mailing address:** 1117 S DOUGLAS BLVD, STE D, MIDWEST CITY, OK 73130-5262
- **Mailing address phone:** (405) 741-8686
- **Mailing address fax:** (405) 733-9621

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | OK | Yes |
| 207RN0300X | Nephrology Physician | — | OK | — |

## Other

- **Enumeration date:** 08/29/2005
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100746130A | — | OK |