Individual
BRADLEY M DUBOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1473 E STATE ROAD 44, CONNERSVILLE, IN 47331-8374
(765) 825-0511
(765) 827-1247
Mailing address
1100 REID PKWY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374-1157
(765) 825-0511
(765) 827-1247
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01045453A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200184980
—
IN
01
—
ANTHEM
000000969484
IN
Enumeration date
03/18/2006
Last updated
05/13/2021
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