Provider Demographics
NPI:1629038542
Name:ABAWI, JABER (MD)
Entity Type:Individual
Prefix:
First Name:JABER
Middle Name:
Last Name:ABAWI
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ976194Medicaid
AZF98772Medicare UPIN
AZR104919Medicare ID - Type Unspecified