Provider Demographics
NPI:1245595875
Name:ALKHALILI, EYAS
Entity type:Individual
Prefix:
First Name:EYAS
Middle Name:
Last Name:ALKHALILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3219
Mailing Address - Country:US
Mailing Address - Phone:813-940-3130
Mailing Address - Fax:
Practice Address - Street 1:5959 WEBB RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3219
Practice Address - Country:US
Practice Address - Phone:813-940-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL166435208600000X
NMRS20140583208600000X
MDD0082842208600000X
TXR9331208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program