Basic Information
| Provider Information | |||||||||
| NPI: | 1356626402 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AL JIBOURY | ||||||||
| FirstName: | HALA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| OtherLastName: | AL-JIBOURY | ||||||||
| OtherFirstName: | HALA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 509 SE RIVERSIDE DR STE 303 | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349942579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722839111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 509 SE RIVERSIDE DR STE 303 | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349942579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722839111 | ||||||||
| FaxNumber: | 7722832955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2011 | ||||||||
| LastUpdateDate: | 10/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME155625 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | A123602 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.