Provider Demographics
NPI:1538259619
Name:JOUBERT, JAMES IRA II (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:IRA
Last Name:JOUBERT
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:I
Other - Last Name:JOUBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1615 DELAWARE ST
Mailing Address - Street 2:BOX 3002
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2367
Mailing Address - Country:US
Mailing Address - Phone:360-414-2000
Mailing Address - Fax:
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:BOX 3002
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2367
Practice Address - Country:US
Practice Address - Phone:360-414-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD600487142083X0100X, 2084N0400X
ORMD290932083X0100X, 2084N0400X
LAMD.2024902084N0400X
SC271942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026112Medicaid
WA242365OtherWA STATE LABOR & INDUSTRIES
WA8527988Medicaid
WAP00766906OtherRAILROAD MEDICARE
WAG8876982Medicare PIN