Provider Demographics
NPI:1477556686
Name:DIB, JEAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:D
Last Name:DIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22792 HARRISBURG WESTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-9224
Mailing Address - Country:US
Mailing Address - Phone:330-823-4000
Mailing Address - Fax:330-829-2919
Practice Address - Street 1:22792 HARRISBURG WESTVILLE RD
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-9224
Practice Address - Country:US
Practice Address - Phone:330-823-4000
Practice Address - Fax:330-829-2919
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076500D207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2151406Medicaid
G66499Medicare UPIN
OHDI0885612Medicare ID - Type Unspecified