Healthcare Provider Details

I. General information

NPI: 1396830915
Provider Name (Legal Business Name): MOHAMMAD JARBOU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S KEENE ST
COLUMBIA MO
65201-6603
US

IV. Provider business mailing address

100 S KEENE ST
COLUMBIA MO
65201-6603
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-9917
  • Fax: 573-777-9919
Mailing address:
  • Phone: 573-777-9917
  • Fax: 573-777-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2002014688
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number2002014688
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2002014688
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: