Provider Demographics
NPI:1427112374
Name:JAALOUK, DINA (MD)
Entity type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:JAALOUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5868 CREEK STATION DR BLDG A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8627
Mailing Address - Country:US
Mailing Address - Phone:850-471-5060
Mailing Address - Fax:850-471-5070
Practice Address - Street 1:5868 CREEK STATION DR BLDG A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8627
Practice Address - Country:US
Practice Address - Phone:850-471-5060
Practice Address - Fax:850-471-5070
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76226208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1427112374OtherNPI
FLG21925Medicare UPIN