Provider Demographics
NPI:1265560049
Name:DUEBER, GEORGE BRIAN (DO)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:BRIAN
Last Name:DUEBER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 N. MONTESANO
Mailing Address - Street 2:PO BOX 2229
Mailing Address - City:WESTPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98595
Mailing Address - Country:US
Mailing Address - Phone:360-268-0195
Mailing Address - Fax:360-268-1442
Practice Address - Street 1:723 N. MONTESANO
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:WA
Practice Address - Zip Code:98595
Practice Address - Country:US
Practice Address - Phone:360-268-0195
Practice Address - Fax:360-268-1442
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8497207Q00000X
WAOP00001786207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA#8312522Medicaid
ND1461174Medicaid
WA#8312522Medicaid