Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME141027 | FL |
N | 208600000X | Surgeon | ME141027 | FL |
Y | 2086S0127X | Trauma Surgeon | ME141027 | FL |
NPI | 1174886386 |
---|---|
Provider Name | Dr. Ibrahim Ihsan Jabbour |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021-5431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107204900 | (05) | FL |