Healthcare Provider Details

I. General information

NPI: 1235150681
Provider Name (Legal Business Name): JAMAL MUBARAK, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N. BONNIE BRAE STREET SUITE 300
DENTON TX
76201-3708
US

IV. Provider business mailing address

209 N BONNIE BRAE ST SUITE 300
DENTON TX
76201-3708
US

V. Phone/Fax

Practice location:
  • Phone: 940-382-5864
  • Fax: 940-382-3939
Mailing address:
  • Phone: 940-382-5864
  • Fax: 940-382-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberK6658
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberK6658
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberK6658
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberK6658
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberK6658
License Number StateTX

VIII. Authorized Official

Name: DR. JAMAL MUBARAK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 940-382-5864