Healthcare Provider Details

I. General information

NPI: 1750538252
Provider Name (Legal Business Name): BENJAMIN JAMES JABARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
TACOMA WA
98431-5000
US

IV. Provider business mailing address

2805 N WASHINGTON ST
TACOMA WA
98407-5943
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3885
  • Fax: 253-968-3278
Mailing address:
  • Phone: 503-961-5116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA136221
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD61112562
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberR1225
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25395
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: