Healthcare Provider Details

I. General information

NPI: 1093374894
Provider Name (Legal Business Name): JAMIL JABER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON RD
MESA AZ
85202-4707
US

IV. Provider business mailing address

1400 S DOBSON RD
MESA AZ
85202-4707
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax: 480-412-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number87594
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR81692
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: