Healthcare Provider Details

I. General information

NPI: 1093746331
Provider Name (Legal Business Name): ABDUL JABBAR BARHOUSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 SW 1ST AVE
OCALA FL
34474-4221
US

IV. Provider business mailing address

712 SE 3RD AVE
OCALA FL
34471-3729
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-3036
  • Fax: 352-368-3940
Mailing address:
  • Phone: 352-732-3036
  • Fax: 352-368-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME21215
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME21215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: