Provider Demographics
NPI:1780926287
Name:AL-JUBOURI, MUSTAFA ADNAN (MD)
Entity type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:ADNAN
Last Name:AL-JUBOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 HUGHES DR STE 220
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-5121
Mailing Address - Country:US
Mailing Address - Phone:419-291-5150
Mailing Address - Fax:419-479-6173
Practice Address - Street 1:2109 HUGHES DR STE 220
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-5121
Practice Address - Country:US
Practice Address - Phone:419-291-5150
Practice Address - Fax:419-479-6173
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35137067208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program