Provider Demographics
NPI:1215914759
Name:JAYBER, MOHAMMED A (DO)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:A
Last Name:JAYBER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 WISTERIA WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2614
Mailing Address - Country:US
Mailing Address - Phone:440-934-7080
Mailing Address - Fax:440-934-0810
Practice Address - Street 1:2217 WISTERIA WAY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2614
Practice Address - Country:US
Practice Address - Phone:440-934-7080
Practice Address - Fax:440-934-0818
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006361207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2041963Medicaid
OHG53276Medicare UPIN
OH4092861Medicare ID - Type Unspecified