Provider Demographics
NPI:1255575825
Name:DE ROULET, JASON (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DE ROULET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8185 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023
Mailing Address - Country:US
Mailing Address - Phone:440-708-1555
Mailing Address - Fax:440-708-1515
Practice Address - Street 1:8185 E WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023
Practice Address - Country:US
Practice Address - Phone:440-708-1555
Practice Address - Fax:440-708-1515
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.099336207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology