Healthcare Provider Details

I. General information

NPI: 1497318646
Provider Name (Legal Business Name): GABY K. JABBOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 NORTHGATE DR
RICHLAND WA
99352-3505
US

IV. Provider business mailing address

120 LOCUST AVE EXT
MOUNT MORRIS PA
15349-1355
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-2516
  • Fax: 509-942-2527
Mailing address:
  • Phone: 724-324-9001
  • Fax: 724-324-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD70096387
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberE-15727
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberE-15727
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34330
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: