Provider Demographics
NPI:1740259605
Name:JABBAR, URUSSA A (DO)
Entity type:Individual
Prefix:
First Name:URUSSA
Middle Name:A
Last Name:JABBAR
Suffix:
Gender:F
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:PO BOX 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:817-852-8190
Mailing Address - Fax:
Practice Address - Street 1:855 MONTGOMERY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2553
Practice Address - Country:US
Practice Address - Phone:817-852-8190
Practice Address - Fax:817-852-8195
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EX906OtherBCBS
TX8P5413OtherBCBS
TX044688203Medicaid
TX044688204Medicaid
TXP01051898OtherRAILROAD MEDICARE
TX044688203Medicaid
TX8P5413OtherBCBS
TX044688204Medicaid