Provider Demographics
NPI:1841492618
Name:JABBAR, SAMAD AHMED (MD)
Entity type:Individual
Prefix:
First Name:SAMAD
Middle Name:AHMED
Last Name:JABBAR
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:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75461-1810
Mailing Address - Country:US
Mailing Address - Phone:903-784-4487
Mailing Address - Fax:903-784-4497
Practice Address - Street 1:870 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-2134
Practice Address - Country:US
Practice Address - Phone:903-784-4487
Practice Address - Fax:903-784-4497
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8731207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0026050OtherINSTITUTIONAL PERMIT
TX196631903Medicaid
BP1-0026050OtherINSTITUTIONAL PERMIT