Healthcare Provider Details

I. General information

NPI: 1780926287
Provider Name (Legal Business Name): MUSTAFA ADNAN AL-JUBOURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HUGHES DR STE 220
TOLEDO OH
43606-5121
US

IV. Provider business mailing address

2109 HUGHES DR STE 220
TOLEDO OH
43606-5121
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-5150
  • Fax: 419-479-6173
Mailing address:
  • Phone: 419-291-5150
  • Fax: 419-479-6173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.137067
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: