Provider Demographics
NPI:1851354559
Name:THURBER, JALIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JALIL
Middle Name:
Last Name:THURBER
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 1:9388 ABBOTT AVE
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2430
Mailing Address - Country:US
Mailing Address - Phone:305-993-1510
Mailing Address - Fax:
Practice Address - Street 1:9388 ABBOTT AVE
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-2430
Practice Address - Country:US
Practice Address - Phone:305-993-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9515207P00000X
FLME96017207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170219302Medicaid
FL275555600Medicaid
TX8D0263Medicare PIN
I23200Medicare UPIN
TX170219302Medicaid