Healthcare Provider Details

I. General information

NPI: 1801640636
Provider Name (Legal Business Name): NAEL MOHD JABER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 E PARRISH AVE STE 102
OWENSBORO KY
42303-3258
US

IV. Provider business mailing address

811 E PARRISH AVE STE 102
OWENSBORO KY
42303-3258
US

V. Phone/Fax

Practice location:
  • Phone: 270-688-2077
  • Fax: 270-688-2078
Mailing address:
  • Phone:
  • Fax: 270-688-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTP231
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: