Healthcare Provider Details

I. General information

NPI: 1003344656
Provider Name (Legal Business Name): ALI HASAN EBRAHIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 W PARKER RD STE 432
PLANO TX
75093-8124
US

IV. Provider business mailing address

6124 W PARKER RD STE 432
PLANO TX
75093-8124
US

V. Phone/Fax

Practice location:
  • Phone: 972-403-3100
  • Fax: 972-403-3105
Mailing address:
  • Phone: 972-403-3100
  • Fax: 972-403-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberW3354
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: