Basic Information
| Provider Information | |||||||||
| NPI: | 1013997493 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JABBARI | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 54 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | OSAGE BEACH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650653050 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1930 N BUSINESS ROUTE 5 | ||||||||
| Address2: | UNIT 1A | ||||||||
| City: | CAMDENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650202659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733465624 | ||||||||
| FaxNumber: | 5733461957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 07/22/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1873 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2007035506 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00625555 | 01 | MO | RAILROAD MEDICARE | OTHER | 242567105 | 05 | MO | MEDICAID | 0186296 | 05 | IA | MEDICAID | 18629 | 01 | IA | BC/BS | OTHER |