Provider Demographics
NPI:1366492589
Name:DEVILLERS, REBECCA E (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:DEVILLERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4343 ALL SEASONS DR
Practice Address - Street 2:STE 220
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1961
Practice Address - Country:US
Practice Address - Phone:614-544-1100
Practice Address - Fax:614-544-1101
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2607D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0514643Medicaid
OHA80601Medicare UPIN
OH0514643Medicaid