Provider Demographics
NPI:1639203276
Name:JABRE, FADY F (MD)
Entity Type:Individual
Prefix:
First Name:FADY
Middle Name:F
Last Name:JABRE
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 1:2720 STONE PARK BLVD
Mailing Address - Street 2:UNITY POINT HEALTH - ST. LUKE'S
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3734
Mailing Address - Country:US
Mailing Address - Phone:712-279-3500
Mailing Address - Fax:820-275-3756
Practice Address - Street 1:2720 STONE PARK BLVD
Practice Address - Street 2:UNITY POINT HEALTH - ST. LUKE'S
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3734
Practice Address - Country:US
Practice Address - Phone:712-279-3500
Practice Address - Fax:620-272-2293
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0426398207P00000X, 207Q00000X
IA39462207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00753162OtherRAILROAD MCARE
KS054539OtherBCBS THRU ST CATS ER
KS100268820BMedicaid
KS100268820DMedicaid
KS930086611OtherRAILROAD THRU ST CATS ER
KS100268820FMedicaid
KS100268820GMedicaid
KS930086611OtherRAILROAD THRU ST CATS ER
KS100268820BMedicaid
KS100268820GMedicaid
KS054539Medicare PIN
KSKA1610021Medicare PIN
KSKA1398022Medicare PIN