Individual
LANCE DIETER DUBBERKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
686 S PIKE ST, SHINNSTON, WV 26431-1043
(304) 592-2100
(304) 592-2102
Mailing address
686 S PIKE ST, STE A, SHINNSTON, WV 26431-1043
(304) 624-4655
(304) 624-3918
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16145
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0052728000
—
WV
Enumeration date
09/20/2006
Last updated
04/21/2022
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