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General NPI Number Information
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NPI Number | 1972833754
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Entity Type | Individual
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Provider Name | ELLAHEH EBRAHIM M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 200 MARTIN LUTHER KING BLVD
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City | WICHITA FALLS
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State | TX
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Zip | 76301-1152
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Country | US
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Telephone | 940-766-6306
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Fax | 940-766-6504
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Provider Business Mailing Address
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Address Line | 200 MARTIN LUTHER KING BLVD
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City | WICHITA FALLS
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State | TX
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Zip | 76301-1152
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Country | US
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Telephone | 940-766-6306
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Fax | 940-766-6504
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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 | 27109
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 281P00000X
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Taxonomy Name | Chronic Disease Hospital
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License Number | 27109
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 27109
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License Number State | OK
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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 | N8909
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License Number State | TX
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