Active NPI
Jack Edward Dubose, MD
- Family Medicine Physician
- Lubbock, TX
National Provider Identifier
1447217880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- L8326
- Practice address
- 7601 Quaker Ave
Lubbock, TX 79424 - Phone
- (806) 725-9563
- Fax
- (806) 725-9500
- NPI assigned
- Apr 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | L8326 | TX | Primary |
| Family Medicine Physician | 207Q00000X | 7422 | NM |
Addresses
Primary practice location
7601 Quaker Ave
Lubbock, TX 79424
Mailing address
3420 22ND Place
Lubbock, TX 79410
Phone (806) 725-7800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 167748601 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L8326 | TX | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248220800000",
"number": "1447217880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3420 22ND PLACE",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "79410",
"telephone_number": "806-725-7800",
"fax_number": "806-723-6532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7601 QUAKER AVE",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "79424",
"telephone_number": "806-725-9563",
"fax_number": "806-725-9500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUBOSE",
"first_name": "JACK",
"middle_name": "EDWARD",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-28",
"last_updated": "2009-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "L8326",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NM",
"license": "7422",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "167748601",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.