Provider Demographics
NPI:1417104779
Name:GEORGE, JIBY OOMMEN (MD FAAP)
Entity Type:Individual
Prefix:DR
First Name:JIBY
Middle Name:OOMMEN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 PRIMERA BLVD STE 135
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2149
Mailing Address - Country:US
Mailing Address - Phone:407-321-0085
Mailing Address - Fax:
Practice Address - Street 1:735 PRIMERA BLVD STE 135
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2149
Practice Address - Country:US
Practice Address - Phone:407-321-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047232208000000X
LA205364208000000X
FLME116204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics