Provider Demographics
NPI:1407827074
Name:JABALY, GEORGES T (MD)
Entity Type:Individual
Prefix:
First Name:GEORGES
Middle Name:T
Last Name:JABALY
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 1:4405 N HOLLAND SYLVANIA RD STE 104
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3533
Mailing Address - Country:US
Mailing Address - Phone:419-882-6784
Mailing Address - Fax:419-882-4795
Practice Address - Street 1:4405 N HOLLAND SYLVANIA RD STE 104
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3533
Practice Address - Country:US
Practice Address - Phone:419-882-6784
Practice Address - Fax:419-882-4795
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-9322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2271689Medicaid
OH4064935Medicare PIN