Provider Demographics
NPI:1972882538
Name:AJ BARHOUSH MD PA
Entity Type:Organization
Organization Name:AJ BARHOUSH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:JABBAR
Authorized Official - Last Name:BARHOUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-732-3036
Mailing Address - Street 1:1054 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0921
Mailing Address - Country:US
Mailing Address - Phone:352-732-3603
Mailing Address - Fax:352-732-6447
Practice Address - Street 1:1054 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0921
Practice Address - Country:US
Practice Address - Phone:352-732-3603
Practice Address - Fax:352-732-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME212152086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
42103OtherMEDICARE ID
FL053996100Medicaid
42103OtherBLUE CROSS & BLUE SHEILD
42103OtherMEDICARE ID