Provider Demographics
NPI:1629199096
Name:EL-JABALI, FAYSSAL (DO)
Entity Type:Individual
Prefix:DR
First Name:FAYSSAL
Middle Name:
Last Name:EL-JABALI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S RENELLIE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2531
Mailing Address - Country:US
Mailing Address - Phone:813-220-9881
Mailing Address - Fax:813-522-3371
Practice Address - Street 1:4178 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6429
Practice Address - Country:US
Practice Address - Phone:813-220-9881
Practice Address - Fax:813-522-3371
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13896207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIN555YMedicare PIN
FLIN555ZMedicare PIN