Provider Demographics
NPI:1043215692
Name:JABBOUR, SAMER (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:
Last Name:JABBOUR
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 1:500 WIND RIDGE DR.
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4173
Mailing Address - Country:US
Mailing Address - Phone:715-847-2611
Mailing Address - Fax:715-847-2612
Practice Address - Street 1:500 WIND RIDGE DR.
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4173
Practice Address - Country:US
Practice Address - Phone:715-847-2611
Practice Address - Fax:715-847-2612
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80983207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0034112OtherNEIGHBORHOOD HEALTH PLAN
6831013OtherHEALTHSOURCE
MAAA19892OtherHARVARD PILGRIM HEALTHCAR
NHF83102OtherANTHEM BLUE CROSS
MA3165078Medicaid
2733012OtherCIGNA
969675OtherNETWORK HEALTH
MA771560OtherTUFTS HEALTH PLAN
MAJ17569OtherBLUE CROSS BLUE SHIELD
25-03479OtherEVERCARE
NH30205047OtherNH MEDICAID
P00187696OtherRAILROAD MEDICARE
MA771560OtherTUFTS HEALTH PLAN
MAJ17569OtherBLUE CROSS BLUE SHIELD