Provider Demographics
NPI:1841270766
Name:JABOUR, VINCENT FERRER (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:FERRER
Last Name:JABOUR
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 1:128 E MILLTOWN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1276
Mailing Address - Country:US
Mailing Address - Phone:330-263-7372
Mailing Address - Fax:330-345-5286
Practice Address - Street 1:128 E MILLTOWN RD
Practice Address - Street 2:STE 206
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1276
Practice Address - Country:US
Practice Address - Phone:330-263-7372
Practice Address - Fax:330-345-5286
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.068804207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0170792Medicaid
OH1497025OtherUNITED MINE WORKERS
OH100008679OtherRAILROAD MEDICARE
OH29-00288OtherUNITED HEALTHCARE
OH000000113270OtherANTHEM BLUE CROSS BLUE SH
OHF32331Medicare UPIN
OH0784511Medicare PIN