Healthcare Provider Details

I. General information

NPI: 1194457879
Provider Name (Legal Business Name): FAREED R JUMAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

1 HOSPITAL DR
COLUMBIA MO
65201-5276
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-3957
  • Fax:
Mailing address:
  • Phone: 732-322-4491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2022025154
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: