Individual
DR. THEODORE M DUBOSE V
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 SUMMIT CENTRE DR, COLUMBIA, SC 29229-7612
(803) 744-9000
(803) 462-0312
Mailing address
601 CLEMSON RD, COLUMBIA, SC 29229-4341
(803) 788-6146
(803) 462-0312
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
21282
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212825
—
SC
Enumeration date
01/12/2006
Last updated
07/15/2019
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