Active NPI
Dewayne N Dubose, ATC, LAT
- Athletic Trainer
- Ormond Beach, FL
National Provider Identifier
1639786940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1971
- Practice address
- 344 Chesham St
Ormond Beach, FL 32174-0692 - Phone
- (813) 362-7729
- NPI assigned
- Sep 30, 2020
- Last updated
- Sep 30, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1971 | FL | Primary |
Addresses
Primary practice location
344 Chesham St
Ormond Beach, FL 32174-0692
Mailing address
344 Chesham St
Ormond Beach, FL 32174-0692
Phone (813) 362-7729
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1971 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601424000000",
"number": "1639786940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "344 CHESHAM ST",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321740692",
"telephone_number": "813-362-7729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "344 CHESHAM ST",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321740692",
"telephone_number": "813-362-7729"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUBOSE",
"first_name": "DEWAYNE",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-30",
"last_updated": "2020-09-30",
"certification_date": "2020-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "1971",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ormond Beach, FL
- Daniel Raymond Drake, D.D.S.
- Dmitry Aleks Drapach, DO
- Dream Life Legacy, Inc. (Seniors Helping Seniors)
- DRVN Physical Therapy & Wellness, LLC
- V John Dsouza, MD SC
- Thomas Dubrule
- Jason Dean Dunlap, DC
- Samuel Wolf Dunlop, NP-C
- Walter James Durkin, MD
- Dva Healthcare Renal Care Inc (Ormond Beach Dialysis)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.