Provider Demographics
NPI:1730199621
Name:ROULEAU, JACINTHE (MD)
Entity type:Individual
Prefix:
First Name:JACINTHE
Middle Name:
Last Name:ROULEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DRIVE 11128 PFP
Mailing Address - Street 2:UNIVERSITY OF IOWA HOSPITALS AND CLINICS
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:319-356-2864
Mailing Address - Fax:319-356-0363
Practice Address - Street 1:200 HAWKINS DRIVE 11128 PFP
Practice Address - Street 2:UNIVERSITY OF IOWA HOSPITALS AND CLINICS
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-356-2864
Practice Address - Fax:319-356-0363
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA36651207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0735993Medicaid
IA25189OtherWELLMARK BCBS
IA0735993Medicaid
IA25189OtherWELLMARK BCBS
IAI18150Medicare ID - Type Unspecified