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General NPI Number Information
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NPI Number | 1720248206
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Entity Type | Individual
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Provider Name | IBRAHIM TAWFIQ FAKHOURI MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 02/08/2018
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Provider Practice Location Address
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Address Line | 861 CORONADO CENTER DR STE 220
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City | HENDERSON
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State | NV
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Zip | 89052-3992
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Country | US
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Telephone | 702-933-1485
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Fax | 702-933-1490
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Provider Business Mailing Address
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Address Line | 861 CORONADO CENTER DR STE 220
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City | HENDERSON
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State | NV
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Zip | 89052-3992
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Country | US
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Telephone | 702-933-1485
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Fax | 702-933-1490
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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 | MD2010-0739
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 109981
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD443512
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14038
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License Number State | NV
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