Provider Demographics
NPI:1306815691
Name:JABOUR, ERNEST RHETT
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:RHETT
Last Name:JABOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ERNEST
Other - Middle Name:RHETT
Other - Last Name:JABOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4131 CALLE BELLEZA
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4223
Mailing Address - Country:US
Mailing Address - Phone:661-858-6106
Mailing Address - Fax:575-522-2031
Practice Address - Street 1:3850 FOOTHILLS
Practice Address - Street 2:SUITE 9
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:661-858-6106
Practice Address - Fax:575-532-1665
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87945207R00000X
NM99226207R00000X
CODR.0053085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM014386OtherBLUE CROSS
NMZ8514Medicaid
NMP00227430OtherRAILROAD MEDICARE
E59193Medicare UPIN
NMP00227430OtherRAILROAD MEDICARE