Provider Demographics
NPI:1326048539
Name:GOUBERT, DEBRIN PACKER (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRIN
Middle Name:PACKER
Last Name:GOUBERT
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 1:344 DUQUESNE WAY
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1458
Mailing Address - Country:US
Mailing Address - Phone:412-741-3544
Mailing Address - Fax:866-885-0424
Practice Address - Street 1:344 DUQUESNE WAY
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1458
Practice Address - Country:US
Practice Address - Phone:412-741-3544
Practice Address - Fax:866-885-0424
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044947L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014851850005Medicaid
PA720716OtherBCBS
PA0014851850005Medicaid
PA720716OtherBCBS