Healthcare Provider Details

I. General information

NPI: 1013997493
Provider Name (Legal Business Name): LINDA S JABBARI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 N BUSINESS ROUTE 5 UNIT 1A
CAMDENTON MO
65020-2659
US

IV. Provider business mailing address

54 HOSPITAL DR
OSAGE BEACH MO
65065-3050
US

V. Phone/Fax

Practice location:
  • Phone: 573-346-5624
  • Fax: 573-346-1957
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1873
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2007035506
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: