Provider Demographics
NPI:1801867957
Name:JABBARI, GHOLAM (MD)
Entity Type:Individual
Prefix:
First Name:GHOLAM
Middle Name:
Last Name:JABBARI
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 1:2104 CEDARWOOD DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2659
Mailing Address - Country:US
Mailing Address - Phone:563-263-4848
Mailing Address - Fax:563-263-3332
Practice Address - Street 1:2104 CEDARWOOD DR
Practice Address - Street 2:STE 200
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2659
Practice Address - Country:US
Practice Address - Phone:563-263-4848
Practice Address - Fax:563-263-3332
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22437207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3182618Medicaid
IAI15053Medicare PIN
IAA01799Medicare UPIN