Healthcare Provider Details

I. General information

NPI: 1669369740
Provider Name (Legal Business Name): YOUSEF SAMUEL EBRAHIM IBRAHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 5TH ST N
COLUMBUS MS
39705-2008
US

IV. Provider business mailing address

506 HOLLY HILLS RD APT 12
COLUMBUS MS
39705-1228
US

V. Phone/Fax

Practice location:
  • Phone: 662-244-1000
  • Fax:
Mailing address:
  • Phone: 662-370-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: