Provider Demographics
NPI:1790836690
Name:AYOUB, JACK PETE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:PETE
Last Name:AYOUB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19490 SANDRIDGE WAY
Mailing Address - Street 2:350
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:703-858-5599
Mailing Address - Fax:703-858-5699
Practice Address - Street 1:19490 SANDRIDGE WAY
Practice Address - Street 2:350
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-858-5599
Practice Address - Fax:703-858-5699
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2015-06-05
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Provider Licenses
StateLicense IDTaxonomies
VA0101244378207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942440953OtherBUSINESS NPI