Provider Demographics
NPI:1033226915
Name:JABER, MOUIN MAHMOUD (MD)
Entity Type:Individual
Prefix:
First Name:MOUIN
Middle Name:MAHMOUD
Last Name:JABER
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:PO BOX 5159
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79117-5159
Mailing Address - Country:US
Mailing Address - Phone:806-381-1732
Mailing Address - Fax:
Practice Address - Street 1:3504 NE 24TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-6920
Practice Address - Country:US
Practice Address - Phone:806-381-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
115836100OtherFIRSTCARE
110182583OtherRAILROAD MEDICARE
TX127659403Medicaid
115836100OtherFIRSTCARE
TX0097BFMedicare PIN