Healthcare Provider Details

I. General information

NPI: 1487641718
Provider Name (Legal Business Name): FATIMA IBRAHIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 S BAUER POINT CIR
SPRING TX
77389-5326
US

IV. Provider business mailing address

PO BOX 132528
SPRING TX
77393-2528
US

V. Phone/Fax

Practice location:
  • Phone: 281-586-8800
  • Fax: 827-586-8822
Mailing address:
  • Phone: 713-876-8407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberM1780
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberM1780
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: