Provider Demographics
NPI:1669426243
Name:ISREB, MAJD (MD)
Entity type:Individual
Prefix:DR
First Name:MAJD
Middle Name:
Last Name:ISREB
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 1:6004 TEE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4925
Mailing Address - Country:US
Mailing Address - Phone:505-327-1157
Mailing Address - Fax:
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2310
Practice Address - Country:US
Practice Address - Phone:360-414-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0641207RN0300X
WAMD00048412207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00104421OtherRAILROAD MEDICARE
WA0224944OtherLABOR & INDUSTRIES
AZ869729Medicaid
WA8945414OtherL&I CRIME VICTIMS
CO83529837Medicaid
WA8493637Medicaid
NM85953865Medicaid
P00104421OtherRAILROAD MEDICARE
AZ100200Medicare Oscar/Certification
I01046Medicare UPIN
AZ869729Medicaid
CO531948Medicare Oscar/Certification