Provider Demographics
NPI:1003839747
Name:MUBARAK, JAMAL (MD)
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:
Last Name:MUBARAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N. BONNIE BRAE STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3708
Mailing Address - Country:US
Mailing Address - Phone:940-382-5864
Mailing Address - Fax:940-382-3939
Practice Address - Street 1:209 N. BONNIE BRAE STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3708
Practice Address - Country:US
Practice Address - Phone:940-382-5864
Practice Address - Fax:940-382-3939
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6658207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029817601Medicaid
TXG83886Medicare UPIN
TX029817601Medicaid
TX00217MMedicare PIN