Provider Demographics
NPI:1528201480
Name:OUBRE, BERT B (MD)
Entity Type:Individual
Prefix:
First Name:BERT
Middle Name:B
Last Name:OUBRE
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 1:602 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3729
Mailing Address - Country:US
Mailing Address - Phone:803-359-0164
Mailing Address - Fax:803-359-0255
Practice Address - Street 1:602 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3729
Practice Address - Country:US
Practice Address - Phone:803-359-0164
Practice Address - Fax:803-359-0255
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine