Healthcare Provider Details

I. General information

NPI: 1487758660
Provider Name (Legal Business Name): ZAVEN JABOURIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6139 GOV GC PEERY HIGHWAY
RICHLANDS VA
24641
US

IV. Provider business mailing address

PO BOX 656 ROUTE 460
DORAN VA
24612
US

V. Phone/Fax

Practice location:
  • Phone: 276-964-7439
  • Fax: 276-963-3070
Mailing address:
  • Phone: 276-964-7439
  • Fax: 276-963-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101044007
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: