Provider Demographics
NPI:1568602837
Name:JUBACH, JEREMY THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:THOMAS
Last Name:JUBACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1003
Mailing Address - Country:US
Mailing Address - Phone:330-744-2118
Mailing Address - Fax:330-744-2110
Practice Address - Street 1:1001 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1003
Practice Address - Country:US
Practice Address - Phone:330-744-2118
Practice Address - Fax:330-744-2110
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014079208G00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program