Individual
IDA JAHED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5555 MONTGOMERY DR, SANTA ROSA, CA 95409-8846
(707) 538-8400
Mailing address
3908 MILLBROOK DR, SANTA ROSA, CA 95404-7613
(216) 386-7221
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
35-087336
OH
207R00000X
Internal Medicine Physician
087336
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000558121
ANTHEM
OH
05
—
2673567
—
OH
01
—
741385
BUCKEYE MEDICAID
OH
01
—
7703850
AETNA
OH
Enumeration date
06/29/2006
Last updated
12/15/2021
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