Basic Information
| Provider Information | |||||||||
| NPI: | 1669426243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISREB | ||||||||
| FirstName: | MAJD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6004 TEE CT | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874024925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053271157 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1615 DELAWARE ST | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604142727 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 2003-0641 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | MD00048412 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | P00104421 | 01 | RAILROAD MEDICARE | OTHER | 0224944 | 01 | WA | LABOR & INDUSTRIES | OTHER | 869729 | 05 | AZ | MEDICAID | 8945414 | 01 | WA | L&I CRIME VICTIMS | OTHER | 83529837 | 05 | CO | MEDICAID | 8493637 | 05 | WA | MEDICAID | 85953865 | 05 | NM | MEDICAID |