Individual
JOSHUA BLAKE DUBOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4015 INTERSTATE 45 N, CONROE, TX 77304-4901
(936) 756-6631
Mailing address
4015 INTERSTATE 45 N, CONROE, TX 77304-4901
(936) 756-6631
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA04882
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
188072603
—
TX
Enumeration date
08/31/2006
Last updated
03/09/2010
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