Provider Demographics
NPI:1407824881
Name:AL-JUBURI UROLOGY, PLLC
Entity Type:Organization
Organization Name:AL-JUBURI UROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMER
Authorized Official - Middle Name:ZEKI
Authorized Official - Last Name:AL-JUBURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-691-4666
Mailing Address - Street 1:10680 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3810
Mailing Address - Country:US
Mailing Address - Phone:703-691-4666
Mailing Address - Fax:703-691-2459
Practice Address - Street 1:10680 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3810
Practice Address - Country:US
Practice Address - Phone:703-691-4666
Practice Address - Fax:703-691-2459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AL-JUBURI UROLOGY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-10
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044731174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC02776Medicare UPIN
VAG01993Medicare PIN