Provider Demographics
NPI:1891712980
Name:ABOU-HARB, JAMIL (MD)
Entity Type:Individual
Prefix:
First Name:JAMIL
Middle Name:
Last Name:ABOU-HARB
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 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-474-2072
Mailing Address - Fax:
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 150E
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-474-5437
Practice Address - Fax:509-474-5438
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000461912080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0210345OtherL&I NUMBER
WA807484200OtherIDAHO MEDICAID
WA8459646OtherWA MEDICAID
WAGAB32999OtherMEDICARE GROUP
WA807484200OtherIDAHO MEDICAID