Provider Demographics
NPI:1336638501
Name:JUBAIR, WIDIAN (MD)
Entity Type:Individual
Prefix:
First Name:WIDIAN
Middle Name:
Last Name:JUBAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8406
Mailing Address - Country:US
Mailing Address - Phone:303-269-2860
Mailing Address - Fax:303-269-2861
Practice Address - Street 1:311 W 14TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2705
Practice Address - Country:US
Practice Address - Phone:719-595-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0007278207R00000X
CODR.0067057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine