Provider Demographics
NPI:1407685621
Name:IBRAHIM, MAZEN MOHAMED IBRAHIM (MD PHD)
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:MOHAMED IBRAHIM
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 W MEADOW DR STE 400
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-5058
Mailing Address - Country:US
Mailing Address - Phone:970-479-7203
Mailing Address - Fax:970-479-7282
Practice Address - Street 1:181 W MEADOW DR
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5242
Practice Address - Country:US
Practice Address - Phone:970-479-7203
Practice Address - Fax:970-479-7282
Is Sole Proprietor?:No
Enumeration Date:2024-07-27
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0074162207X00000X, 207XP3100X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery