| Doctor Name: | JESSICA S SUBER |
| NPI Number: | 1033379375 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | TRN122224 |
| Business Practice Address: | 1711 27th St Braunlin Building, Suite 402 Portsmouth, OH - 456622654 |
| Business Phone Number: | 7403563562 |
| Business Fax Number: | 7403556938 |
| Mailing Address: | 1735 27th St, Waller Building, Suite B06 PORTSMOUTH |
| State: | OH |
| Postal Code: | 456622677 |
| Phone Number: | 7403568681 |
| Fax Number: | 7403537900 |
| NPI Enumeration Date: | 06/10/2008 |
| NPI Last Update Date: | 07/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | TRN122224 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |