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General NPI Number Information
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NPI Number | 1013131119
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Entity Type | Individual
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Provider Name | ALBERT KENNETH JABBOUR PA
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 9500 BONITA BEACH RD SE STE 100
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4698
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Country | US
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Telephone | 239-498-9294
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Fax | 239-798-7179
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE FL 2
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City | FORT MYERS
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State | FL
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Zip | 33901-9342
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Country | US
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Telephone | 877-856-3774
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Fax | 239-798-7179
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9117096
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 516
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License Number State | WV
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