Provider Demographics
NPI:1235150681
Name:JAMAL MUBARAK, M.D., PA
Entity Type:Organization
Organization Name:JAMAL MUBARAK, M.D., PA
Other - Org Name:TEXAS LUNG ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUBARAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-382-5864
Mailing Address - Street 1:209 N BONNIE BRAE ST
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6658207RA0201X, 207RC0000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10030136OtherAMERIGROUP
TX029817601Medicaid
TX0084EUOtherBCBS
TX0A3670Medicare PIN
TX10030136OtherAMERIGROUP