Healthcare Provider Details

I. General information

NPI: 1215914759
Provider Name (Legal Business Name): MOHAMMED A JAYBER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 WISTERIA WAY
AVON OH
44011-2614
US

IV. Provider business mailing address

2217 WISTERIA WAY
AVON OH
44011-2614
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-7080
  • Fax: 440-934-0818
Mailing address:
  • Phone: 440-934-7080
  • Fax: 440-934-0810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number34006361
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: