Provider Demographics
NPI:1396729372
Name:AL-JUBURI, AMER Z (MD)
Entity type:Individual
Prefix:
First Name:AMER
Middle Name:Z
Last Name:AL-JUBURI
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 1:10680 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3810
Mailing Address - Country:US
Mailing Address - Phone:703-691-4666
Mailing Address - Fax:703-691-2459
Practice Address - Street 1:10680 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3810
Practice Address - Country:US
Practice Address - Phone:703-691-4666
Practice Address - Fax:703-691-2459
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044731174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC02776Medicare UPIN
VAG01993A01Medicare PIN