Provider Demographics
NPI:1649221888
Name:DEBOURBON, ERNEST (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:DEBOURBON
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 1:5060 BRADENTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3511
Mailing Address - Country:US
Mailing Address - Phone:614-793-8346
Mailing Address - Fax:614-793-8349
Practice Address - Street 1:5060 BRADENTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3511
Practice Address - Country:US
Practice Address - Phone:614-793-8346
Practice Address - Fax:614-793-8349
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-3780-D208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG78342Medicare UPIN