Provider Demographics
NPI:1164407532
Name:DOUMET, BOUCHRA S (MD)
Entity Type:Individual
Prefix:
First Name:BOUCHRA
Middle Name:S
Last Name:DOUMET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:567-585-0380
Mailing Address - Fax:567-585-0381
Practice Address - Street 1:6175 LEVIS COMMONS BLVD # 104
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551
Practice Address - Country:US
Practice Address - Phone:567-585-0380
Practice Address - Fax:567-585-0381
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2524316Medicaid
OHP00358429OtherRAILROAD MEDICARE
OHDO4150824Medicare PIN
OHP00358429OtherRAILROAD MEDICARE