Provider Demographics
NPI:1780613802
Name:RIEBMAN, JEROME BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:BRIAN
Last Name:RIEBMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5906 SAILING HAWK AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-7313
Mailing Address - Country:US
Mailing Address - Phone:707-538-5503
Mailing Address - Fax:707-538-5507
Practice Address - Street 1:3421 VILLA LN
Practice Address - Street 2:SUITE 2A
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6402
Practice Address - Country:US
Practice Address - Phone:707-254-9640
Practice Address - Fax:707-254-9698
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG79642208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G796420Medicaid
CA00G796420Medicaid
CA00G796420Medicare PIN