MEDICARE: DR. ANTOINE I JABBOUR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	17674	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200036113	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588632905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTOINE I JABBOUR MD

Provider Business Mailing Address
First Line	:	4802 S 109TH E AVENUE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146
Country	:	US
Telephone Number	:	918-392-1400
Fax Number	:	918-392-1488

Provider Business Practice Location Address
First Line	:	4802 S 109TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-5822
Country	:	US
Telephone Number	:	918-392-1400
Fax Number	:	918-392-1488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	02/08/2017

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