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Individual

DR. GREGORY VAN DUBAY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
875 FRIENDSHIP RD STE J, TALLASSEE, AL 36078-1256
(334) 283-4178
(334) 283-2190
Mailing address
PO BOX 780367, TALLASSEE, AL 36078-0004
(334) 283-4178
(334) 283-2190

Taxonomy

Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
AL71
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
051552056
MEDICARE PROVIDER
AL
05
051552056
AL
01
1841468238
GROUP NPI
AL
01
515-12528
BCBSAL
AL
Enumeration date
12/04/2006
Last updated
09/28/2010
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