Healthcare Provider Details

I. General information

NPI: 1306875422
Provider Name (Legal Business Name): GEORGES ABDO EL BAHRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 KENNERLY RD SUITE 101
JACKSONVILLE FL
32216-4368
US

IV. Provider business mailing address

6100 KENNERLY RD SUITE 101
JACKSONVILLE FL
32216-4368
US

V. Phone/Fax

Practice location:
  • Phone: 904-739-0050
  • Fax: 904-828-4605
Mailing address:
  • Phone: 904-739-0050
  • Fax: 904-828-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME0027372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: