Provider Demographics
NPI:1699975540
Name:IBRAHIM, IBRAHIM FUAD (MD)
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:FUAD
Last Name:IBRAHIM
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:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:469-291-2841
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:5323 HARRY HINES BLVD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-633-5555
Practice Address - Fax:214-648-1955
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6372207RH0000X, 207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EN191OtherBLUE CROSS BLUE SHIELD
TX339636801Medicaid
TX355723YMVQMedicare PIN