1487641718 NPI number — DR. FATIMA IBRAHIM M.D.

Table of content: DR. FATIMA IBRAHIM M.D. (NPI 1487641718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487641718 NPI number — DR. FATIMA IBRAHIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IBRAHIM
Provider First Name:
FATIMA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487641718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 132528
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77393-2528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-876-8407
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
174 S BAUER POINT CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77389-5326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-586-8800
Provider Business Practice Location Address Fax Number:
827-586-8822
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  M1780 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X , with the licence number: M1780 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00106W . This is a "MHS PHYS OF TX GRP PTAN - HARRIS COUNTY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153449704 . This is a "MHS PHYS OF TX MEDICAID GRP TPI - HARRIS COUNTY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 351187YNBT . This is a "MDCR PTAN MONTGOMERY CO." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 351179YNBT . This is a "MDCR PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0035TD . This is a "MHS PHYS OF TX BCBSTX GRP PROV REC #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00659N . This is a "MHS PHYS OF TX GRP PTAN - MONTGOMERY COUNTY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153449706 . This is a "MHS PHYS OF TX MEDICAID GRP TPI - MONTGOMERY COUNTY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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