Provider Demographics
NPI:1508863358
Name:JABBOUR, BADIA (MD)
Entity Type:Individual
Prefix:DR
First Name:BADIA
Middle Name:
Last Name:JABBOUR
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 1:18603 WILLAMETTE DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1705
Mailing Address - Country:US
Mailing Address - Phone:503-699-3313
Mailing Address - Fax:503-699-3365
Practice Address - Street 1:18603 WILLAMETTE DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1705
Practice Address - Country:US
Practice Address - Phone:503-699-3313
Practice Address - Fax:503-699-3365
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500604142Medicaid