Provider Demographics
NPI:1396949954
Name:GERGES EL KHOURY, JOE E (MD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:E
Last Name:GERGES EL KHOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:KHOURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:904-398-3262
Mailing Address - Fax:904-265-6407
Practice Address - Street 1:1375 ROBERTS DR
Practice Address - Street 2:SUITE 204
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3210
Practice Address - Country:US
Practice Address - Phone:904-247-0056
Practice Address - Fax:904-241-0065
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23110207RG0100X
FLME111347207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012254Medicaid
FLPENDINGMedicaid
WV3810012254Medicaid