Provider Demographics
NPI:1427304963
Name:DABBAH, JAMAL D (MD)
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:D
Last Name:DABBAH
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 1:1840 E WARNER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3445
Mailing Address - Country:US
Mailing Address - Phone:480-420-6303
Mailing Address - Fax:480-840-1672
Practice Address - Street 1:2150 S COUNTRY CLUB DR STE 27
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6860
Practice Address - Country:US
Practice Address - Phone:623-252-0881
Practice Address - Fax:602-313-1914
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 102L00000X, 103K00000X, 103T00000X, 133N00000X, 133V00000X, 171M00000X, 224Z00000X, 225C00000X
AZ51454207R00000X, 208100000X, 208D00000X, 225100000X, 225X00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ51454OtherMD LICENSE
AZFD5697416OtherDEA LICENSE