Provider Demographics
NPI:1114361441
Name:JIBAWI, MOHAMAD KHALID (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:KHALID
Last Name:JIBAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:727-271-8725
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:5522 TROUBLE CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:NEW PRT RCHY
Practice Address - State:FL
Practice Address - Zip Code:34652-5171
Practice Address - Country:US
Practice Address - Phone:727-788-3070
Practice Address - Fax:727-788-3072
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127256208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017619500Medicaid
FL017619500Medicaid
FLIQ081XMedicare PIN
FLIQ081ZMedicare PIN