Provider Demographics
NPI:1992401319
Name:IBRAHIM JABBOUR MD PLLC
Entity type:Organization
Organization Name:IBRAHIM JABBOUR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:IHSAN
Authorized Official - Last Name:JABBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-454-9114
Mailing Address - Street 1:8806 SONOMA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4069
Mailing Address - Country:US
Mailing Address - Phone:561-454-9114
Mailing Address - Fax:
Practice Address - Street 1:2560 RCA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3336
Practice Address - Country:US
Practice Address - Phone:561-799-9559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty