Provider Demographics
NPI:1609162304
Name:REBOUL, JEFFERY P (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:P
Last Name:REBOUL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:
Other - Last Name:REBOUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2545 SCHOENERSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017
Mailing Address - Country:US
Mailing Address - Phone:484-884-2888
Mailing Address - Fax:
Practice Address - Street 1:2545 SCHOENERSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017
Practice Address - Country:US
Practice Address - Phone:484-884-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014281207P00000X
LA305290207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine