Provider Demographics
NPI:1922214352
Name:JOUDEH, JAMAL (MD)
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:
Last Name:JOUDEH
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 1:4724 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2339
Mailing Address - Country:US
Mailing Address - Phone:850-696-4000
Mailing Address - Fax:850-435-9608
Practice Address - Street 1:4724 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2339
Practice Address - Country:US
Practice Address - Phone:850-696-4000
Practice Address - Fax:850-435-9608
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112975207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7920283OtherCIGNA
FLP01428446OtherRR MEDICARE
PAMT183299OtherGRADUATE MEDICAL TRAINEE
FL1178638OtherWELLCARE
FL14K7WOtherBCBS
FLGC718YOtherMEDICARE
FL7267946OtherAETNA
FLGC718YOtherMEDICARE