Basic Information
| Provider Information | |||||||||
| NPI: | 1750538252 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JABARA | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2805 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984075943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039615116 | ||||||||
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| Practice Location | |||||||||
| Address1: | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984315000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539683885 | ||||||||
| FaxNumber: | 2539683278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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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 | 2085R0204X | A136221 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 208D00000X | 25395 | NE | N | Allopathic & Osteopathic Physicians | General Practice | 2085R0204X | R1225 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.