Basic Information
| Provider Information | |||||||||
| NPI: | 1871563445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHOURY | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | GEORGE | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 12502 USF PINE DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336129411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139722250 | ||||||||
| FaxNumber: | 8139757129 | ||||||||
| Practice Location | |||||||||
| Address1: | 12502 USF PINE DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336129411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139722250 | ||||||||
| FaxNumber: | 8139757129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 04/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | 28108 | AL | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 207X00000X | MD-423988 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 2086S0120X | ME130124 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | 051591742 | 01 | AL | BLUE CROSS | OTHER | 009942846 | 05 | AL | MEDICAID | 051541034 | 01 | AL | BLUE CROSS | OTHER | 051109076 | 01 | AL | BLUE CROSS | OTHER | 051541030 | 01 | AL | BLUE CROSS | OTHER | 051541033 | 01 | AL | BLUE CROSS | OTHER | 009942847 | 05 | AL | MEDICAID | 04500046 | 05 | MS | MEDICAID | 051547826 | 01 | AL | BLUE CROSS | OTHER | 51598791 | 01 | AL | BLUE CROSS | OTHER | 051541032 | 01 | AL | BLUE CROSS | OTHER | 100915 | 05 | AL | MEDICAID | 009942850 | 05 | AL | MEDICAID | 051541027 | 01 | AL | BLUE CROSS | OTHER | 102775 | 01 | AL | BLUE CROSS | OTHER | 121707 | 05 | AL | MEDICAID | 009942849 | 05 | AL | MEDICAID | 051542848 | 05 | AL | MEDICAID |