Provider Demographics
NPI:1952034530
Name:JADALLAH, SAMER IBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:IBRAHIM
Last Name:JADALLAH
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 1:5323 HARRY HINES BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DALLS
Mailing Address - State:TX
Mailing Address - Zip Code:75390
Mailing Address - Country:US
Mailing Address - Phone:214-648-3848
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390
Practice Address - Country:US
Practice Address - Phone:214-648-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2023-03-17
Deactivation Date:2023-03-13
Deactivation Code:
Reactivation Date:2023-03-17
Provider Licenses
StateLicense IDTaxonomies
TXBP10078079390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program