Provider Demographics
NPI:1063881076
Name:DEANAH A JIBRIL, DO, PA
Entity type:Organization
Organization Name:DEANAH A JIBRIL, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JIBRIL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-832-0761
Mailing Address - Street 1:3212 SAINT GEORGES DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4719
Mailing Address - Country:US
Mailing Address - Phone:817-832-0761
Mailing Address - Fax:972-608-4693
Practice Address - Street 1:4001 W 15TH ST
Practice Address - Street 2:SUITE 375
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5841
Practice Address - Country:US
Practice Address - Phone:972-867-4880
Practice Address - Fax:972-867-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9718207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG69656Medicare UPIN