Provider Demographics
NPI:1356626402
Name:AL JIBOURY, HALA
Entity Type:Individual
Prefix:
First Name:HALA
Middle Name:
Last Name:AL JIBOURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HALA
Other - Middle Name:
Other - Last Name:AL-JIBOURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:509 SE RIVERSIDE DR STE 303
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2579
Mailing Address - Country:US
Mailing Address - Phone:772-283-9111
Mailing Address - Fax:
Practice Address - Street 1:3000 MEDICAL PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-6600
Practice Address - Country:US
Practice Address - Phone:813-615-7028
Practice Address - Fax:813-615-8008
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123602207RG0100X
FLME155625207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology