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General NPI Number Information
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NPI Number | 1174311765
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Entity Type | Organization
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Legal Business Name | THE LONGEVITY LAB LLC
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 100 S KEENE ST
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City | COLUMBIA
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State | MO
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Zip | 65201-6603
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Country | US
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Telephone | 573-968-6822
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Fax |
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Provider Business Mailing Address
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Address Line | 100 S KEENE ST
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City | COLUMBIA
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State | MO
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Zip | 65201-6603
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Country | US
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Telephone | 573-968-6822
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. MOHAMMAD JARBOU
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Credential | MD
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Telephone | 573-639-0292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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