Healthcare Provider Details

I. General information

NPI: 1750794699
Provider Name (Legal Business Name): DAVID JALAL EL HASSAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 BLANDING BLVD STE 102
MIDDLEBURG FL
32068-4935
US

IV. Provider business mailing address

330 CORPORATE WAY STE 200
ORANGE PARK FL
32073-6214
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-8801
  • Fax: 833-578-1804
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-866-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME129410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: