Provider Demographics
NPI:1639270192
Name:REBOULET, JAMES DOW (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DOW
Last Name:REBOULET
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 1:300 HIGH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-6078
Mailing Address - Country:US
Mailing Address - Phone:513-454-1460
Mailing Address - Fax:513-863-3053
Practice Address - Street 1:903 NW WASHINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6367
Practice Address - Country:US
Practice Address - Phone:513-454-1111
Practice Address - Fax:513-737-1592
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-2677-R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0314118Medicaid
OH0426123Medicare PIN
OH0314118Medicaid