Provider Demographics
NPI:1396846457
Name:JABER ABAWI MD INC
Entity Type:Organization
Organization Name:JABER ABAWI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JABER
Authorized Official - Middle Name:JM
Authorized Official - Last Name:ABAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-474-5286
Mailing Address - Street 1:PO BOX 2159
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547-2159
Mailing Address - Country:US
Mailing Address - Phone:928-474-5286
Mailing Address - Fax:928-474-0008
Practice Address - Street 1:1106 N BEELINE HWY
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-3714
Practice Address - Country:US
Practice Address - Phone:928-474-5286
Practice Address - Fax:928-474-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ976194Medicaid
AZ976194Medicaid