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General NPI Number Information
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NPI Number | 1659594752
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Entity Type | Individual
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Provider Name | NASHAAT BOTROUS IBRAHEIM MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 12121 RICHMOND AVE SUITE 412
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City | HOUSTON
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State | TX
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Zip | 77082-2437
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Country | US
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Telephone | 281-558-5656
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Fax | 281-558-5667
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Provider Business Mailing Address
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Address Line | 12121 RICHMOND AVE SUITE 412
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City | HOUSTON
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State | TX
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Zip | 77082-2437
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Country | US
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Telephone | 281-558-5656
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Fax | 281-558-5667
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K4089
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License Number State | TX
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