Provider Demographics
NPI:1629064308
Name:JABBOURY, KHALED W (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:W
Last Name:JABBOURY
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 1:12121 RICHMOND AVE
Mailing Address - Street 2:#100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2432
Mailing Address - Country:US
Mailing Address - Phone:281-558-5385
Mailing Address - Fax:281-558-6589
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:#100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2432
Practice Address - Country:US
Practice Address - Phone:281-558-5385
Practice Address - Fax:281-558-6589
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6443174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP089970B1Medicaid
TX89970BMedicare ID - Type Unspecified
TXE02265Medicare UPIN