Healthcare Provider Details

I. General information

NPI: 1578729406
Provider Name (Legal Business Name): ALI H. ABDUL JABBAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5398 PARK ST N
ST PETERSBURG FL
33709-1041
US

IV. Provider business mailing address

5398 PARK ST N
ST PETERSBURG FL
33709-1041
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-1441
  • Fax: 727-545-8263
Mailing address:
  • Phone: 727-544-1441
  • Fax: 727-545-8263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME132123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: