Provider Demographics
NPI:1225043805
Name:JABUR, RAZZAK (MD)
Entity Type:Individual
Prefix:DR
First Name:RAZZAK
Middle Name:
Last Name:JABUR
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 1:509 N ALLEGHANEY
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761
Mailing Address - Country:US
Mailing Address - Phone:432-332-0231
Mailing Address - Fax:432-332-2116
Practice Address - Street 1:509 N ALLEGHANEY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-332-0231
Practice Address - Fax:432-332-2116
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3319208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C17327Medicare UPIN
TX00T003Medicare PIN