Individual
MR. GLEN LOUIS DUBOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2502 MORGAN AVE, CORPUS CHRISTI, TX 78405-1807
(361) 888-6782
(361) 882-3076
Mailing address
2502 MORGAN AVE, CORPUS CHRISTI, TX 78405-1807
(361) 888-6782
(361) 882-3076
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA004465
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00069083
BLUE SHIELD
VT
Enumeration date
11/01/2006
Last updated
07/08/2007
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