Provider Demographics
NPI:1770014177
Name:JABBOUR, HOSSAM (MD)
Entity Type:Individual
Prefix:
First Name:HOSSAM
Middle Name:
Last Name:JABBOUR
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 1:801 EASTERN BYP
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2751
Mailing Address - Country:US
Mailing Address - Phone:859-625-3603
Mailing Address - Fax:859-625-3757
Practice Address - Street 1:750 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:606-439-3557
Practice Address - Fax:606-436-6988
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53346207P00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist