Provider Demographics
NPI:1104104637
Name:JALAB, FERAS (MD)
Entity type:Individual
Prefix:
First Name:FERAS
Middle Name:
Last Name:JALAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMED
Other - Middle Name:FERAS
Other - Last Name:JALAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17310 WRIGHT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2405
Mailing Address - Country:US
Mailing Address - Phone:833-228-6889
Mailing Address - Fax:
Practice Address - Street 1:17310 WRIGHT ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2405
Practice Address - Country:US
Practice Address - Phone:833-228-6889
Practice Address - Fax:877-853-0376
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS80482085R0202X
ND183482085R0202X
WY14398C2085R0202X
390200000X
FLME1544172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program