JOSUE FLORES DABOUB (NPI# 1306108105) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1306108105 |
Entity Type | Individual |
Full Name | JOSUE FLORES DABOUB |
Credential | M.D. |
Practice Address |
530 Ne Glen Oak Ave Peoria IL 61637-0001 |
Practice Telephone | 3096243313 |
Mailing Telephone | 3092643313 |
Enumeration Date | 2012-06-08 |
Last Update Date | 2016-12-16 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
9791717-1205 | UT | Allopathic & Osteopathic Physicians |
N | 208000000X | Pediatrics | 036130096 | IL | Allopathic & Osteopathic Physicians |
Street Address |
530 NE GLEN OAK AVE |
City | PEORIA |
State | IL |
Zip Code | 61637-0001 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1346235777 | Jack Michael Gibson | Obstetrics & Gynecology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2005-09-12 |
1053912188 | Janie Clary | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-11-04 |
1265030548 | Christina David | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-10-09 |
1033726831 | Corry Lynn Rediger | Occupational Therapist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-25 |
1720694094 | Katelynn M Madden | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-21 |
1568074474 | Amanda Diane Beoletto | Pharmacist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-08-21 |
1881212892 | Mohammad Mousbah Al-tabbaa | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
1750909693 | Mohammad Gareeb | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
1376160846 | Bassel Elia Abouzeid | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637 | 2020-07-01 |
1700403516 | Christina Marie Spurgeon | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-06-26 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
1518328665 | Jenna Bishop | Dietitian, Registered | 600 Ne Water Street, Peoria, IL 61637 | 2016-03-17 |
1194133850 | Ashish Kumar Roy | Internal Medicine | 530 N.e. Glen Oak Ave, Peoria, IL 61637 | 2014-07-25 |
1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
Find all providers in zip 61637 |
Taxonomy Code | 207SG0201X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Medical Genetics |
Specialization | Clinical Genetics (M.D.) |
A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. |
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1043474893 | Serendestiny Enterprise LLC | Medical Genetics | 3555 Vanilla Grass Dr, Naperville, IL 60564-8331 | 2008-07-10 |
1164447413 | Lee Shulman | Medical Genetics | 675 N St Clair Street, Galter Suite 14-200, Chicago, IL 60611-5966 | 2006-07-13 |
1962466375 | Joel Martin Charrow | Medical Genetics | Ann& Robert H. Lurie Children's Hospital of Chicago #59, 225 E Chicago Ave, Chicago, IL 60611-2991 | 2006-04-13 |
1427026897 | Brad Angle | Medical Genetics | 1875 Dempster St Ste 285, Park Ridge, IL 60068-1157 | 2006-03-10 |
1629051289 | Rhonda Spiro | Medical Genetics | 1801 W Taylor St Ste 2e, Chicago, IL 60612-4795 | 2005-11-28 |
1134534597 | Joshua Baker | Medical Genetics | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2014-06-24 |
1972883254 | Gifty Bhat | Medical Genetics | 1801 W Taylor St Ste 2e, Ui Health Occ, Chicago, IL 60612-4795 | 2011-08-18 |
1043410772 | Neuromed Clinic LLC | Medical Genetics | 25 N Winfield Rd, Ste 500, Winfield, IL 60190-1222 | 2007-07-20 |
1669595872 | Darrel Waggoner | Medical Genetics | 5841 S Maryland Ave, Mc 0077 Room O-500, Chicago, IL 60637-1447 | 2007-04-10 |
1538282736 | William Brian Dobyns | Medical Genetics | 5841 S Maryland Ave, Mc 0077, Chicago, IL 60637-1447 | 2007-04-10 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.