Provider Demographics
NPI:1568726644
Name:JARADAT, MOHAMMAD M (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:M
Last Name:JARADAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E SILVERADO RANCH BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7518
Mailing Address - Country:US
Mailing Address - Phone:702-240-6482
Mailing Address - Fax:702-671-2376
Practice Address - Street 1:10210 N 92ND ST STE 301
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4525
Practice Address - Country:US
Practice Address - Phone:602-867-8644
Practice Address - Fax:602-606-5128
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15968207R00000X, 207RI0011X, 207RC0000X
AZ53895207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology