Healthcare Provider Details

I. General information

NPI: 1992401319
Provider Name (Legal Business Name): IBRAHIM JABBOUR MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 RCA BLVD STE 106
PALM BEACH GARDENS FL
33410-3336
US

IV. Provider business mailing address

8806 SONOMA LAKE BLVD
BOCA RATON FL
33434-4069
US

V. Phone/Fax

Practice location:
  • Phone: 561-799-9559
  • Fax:
Mailing address:
  • Phone: 561-454-9114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IBRAHIM IHSAN JABBOUR
Title or Position: OWNER
Credential: MD
Phone: 561-454-9114