Provider Demographics
NPI:1063447514
Name:JIFI-BAHLOOL, HAITHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HAITHAM
Middle Name:
Last Name:JIFI-BAHLOOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAITHAM
Other - Middle Name:
Other - Last Name:JIFI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:7326 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5509
Mailing Address - Country:US
Mailing Address - Phone:361-991-0112
Mailing Address - Fax:361-991-0181
Practice Address - Street 1:7326 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5509
Practice Address - Country:US
Practice Address - Phone:361-991-0112
Practice Address - Fax:361-991-0181
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG26912Medicare UPIN
TX00338MMedicare PIN