Provider Demographics
NPI:1114361441
Name:JIBAWI, MOHAMAD KHALID (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:KHALID
Last Name:JIBAWI
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 1:14690 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:
Practice Address - Street 1:7633 CITA LN
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6219
Practice Address - Country:US
Practice Address - Phone:727-372-1005
Practice Address - Fax:321-463-9533
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127256208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017619500Medicaid
FL017619500Medicaid
FLIQ081XMedicare PIN
FLIQ081ZMedicare PIN