Provider Demographics
NPI:1295789444
Name:ALSABBAGH, EYAD (MD)
Entity type:Individual
Prefix:
First Name:EYAD
Middle Name:
Last Name:ALSABBAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12148 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5575
Mailing Address - Country:US
Mailing Address - Phone:352-597-7184
Mailing Address - Fax:352-597-7186
Practice Address - Street 1:12148 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-597-7184
Practice Address - Fax:352-597-7186
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME884992081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0126097OtherGHI
294540OtherAVMED
FL48130OtherBCBS
FL01811OtherUNIVERSAL
FL286112OtherWELLCARE & HEALTHEASE
FL48130OtherBCBS
P00336154OtherRAILROAD MEDICARE
0126097OtherGHI