Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 34006361 | OH |
NPI | 1215914759 |
---|---|
Provider Name | Mohammed A Jayber |
First Address | Avon, OH 44011-2614 |
Second Address | Avon, OH 44011-2614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 01/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2041963 | (05) | OH |
G53276 | (02) | OH |