Provider Demographics
NPI:1316967102
Name:FRANCIS ROBERTO IBARRA MD PA
Entity type:Organization
Organization Name:FRANCIS ROBERTO IBARRA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-348-0426
Mailing Address - Street 1:PO BOX 203616
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-3636
Mailing Address - Country:US
Mailing Address - Phone:281-358-8114
Mailing Address - Fax:281-358-0609
Practice Address - Street 1:15101 EAST FWY
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4104
Practice Address - Country:US
Practice Address - Phone:713-626-3379
Practice Address - Fax:713-626-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3896207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0038BROtherBLUE CROSS/BLUE SHIELD
TX148158201Medicaid
TX00903ROtherBLUE CROSS/BLUE SHIELD
TX149576401Medicaid
TX00903RMedicare PIN
TX0038BRMedicare PIN