Provider Demographics
NPI:1093746331
Name:BARHOUSH, ABDUL JABBAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:JABBAR
Last Name:BARHOUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3729
Mailing Address - Country:US
Mailing Address - Phone:352-732-3036
Mailing Address - Fax:352-368-3940
Practice Address - Street 1:1054 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4221
Practice Address - Country:US
Practice Address - Phone:352-732-3036
Practice Address - Fax:352-368-3940
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME212152086S0129X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42103OtherBLUE CROSS & BLUE SHIELD
FL053996100Medicaid
FL053996100Medicaid
FL42103OtherBLUE CROSS & BLUE SHIELD