MEDICARE: DR. VIVIAN SAMI EBRAHIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	R4961	TX

General Provider Information

NPI Number	:	1073870440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIAN SAMI EBRAHIM M.D.

Provider Business Mailing Address
First Line	:	1216 CHURCH ST
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2108
Country	:	US
Telephone Number	:	903-558-2222
Fax Number	:	903-558-2225

Provider Business Practice Location Address
First Line	:	1216 CHURCH ST
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2108
Country	:	US
Telephone Number	:	903-558-2222
Fax Number	:	903-558-2225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	01/23/2024

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