Provider Demographics
NPI:1487813630
Name:AL-DABAGH, HIBA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:HIBA
Middle Name:
Last Name:AL-DABAGH
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40124 HIGHWAY 27 STE 102
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-5905
Mailing Address - Country:US
Mailing Address - Phone:863-419-7509
Mailing Address - Fax:
Practice Address - Street 1:40124 HIGHWAY 27 STE 102
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-5905
Practice Address - Country:US
Practice Address - Phone:863-419-7509
Practice Address - Fax:863-419-7824
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104366207RE0101X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 104366OtherMEDICAL LICENSE #
FLPTANDF759ZOtherMEDICARE PTAN