Healthcare Provider Details

I. General information

NPI: 1114361441
Provider Name (Legal Business Name): MOHAMAD KHALID JIBAWI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5522 TROUBLE CREEK RD STE 102
NEW PRT RCHY FL
34652-5171
US

IV. Provider business mailing address

5400 PINEHURST DR
SPRING HILL FL
34606-3833
US

V. Phone/Fax

Practice location:
  • Phone: 727-788-3070
  • Fax: 727-788-3072
Mailing address:
  • Phone: 727-271-8725
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME127256
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME127256
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: