Provider Demographics
NPI:1588994693
Name:IBARRA, AURELIO (MD)
Entity type:Individual
Prefix:
First Name:AURELIO
Middle Name:
Last Name:IBARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-7418
Mailing Address - Country:US
Mailing Address - Phone:214-826-2151
Mailing Address - Fax:214-826-2639
Practice Address - Street 1:5315 ROSS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7418
Practice Address - Country:US
Practice Address - Phone:214-826-2151
Practice Address - Fax:214-826-2639
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine