Healthcare Provider Details

I. General information

NPI: 1518152867
Provider Name (Legal Business Name): WAGIH WILLIAM IBRAHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N FRESNO ST
FRESNO CA
93701-2302
US

IV. Provider business mailing address

5025 W BROWNING AVE
FRESNO CA
93722-7707
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6500
  • Fax:
Mailing address:
  • Phone: 559-275-7412
  • Fax: 559-275-7412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA99134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: