Basic Information
| Provider Information | |||||||||
| NPI: | 1376565648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOUBLER | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAVAS | ||||||||
| OtherFirstName: | REBECCA | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7001 S EDGERTON RD | ||||||||
| Address2: | STE A | ||||||||
| City: | BRECKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441414206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407170591 | ||||||||
| FaxNumber: | 4407170594 | ||||||||
| Practice Location | |||||||||
| Address1: | 5319 HOAG DR | ||||||||
| Address2: | |||||||||
| City: | SHEFFIELD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440351494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409306050 | ||||||||
| FaxNumber: | 4409348882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 03/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35-083608R | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 000000221235 | 01 | OH | UNISON | OTHER | 2486706 | 05 | OH | MEDICAID | 7867591 | 01 | OH | AETNA | OTHER | P00137563 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000516058 | 01 | OH | ANTHEM | OTHER | 1376565648 | 01 | MI | MICHIGAN MEDICAID | OTHER | 0583328 | 01 | OH | BCMH | OTHER | 363938 | 01 | OH | WELLCARE MEDICAID | OTHER | 750527 | 01 | OH | BUCKEYE MEDICAID | OTHER | P00398018 | 01 | OH | RAILROAD MEDICARE | OTHER | P00764393 | 01 | OH | MEDICARE RAILROAD | OTHER |