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General NPI Number Information
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NPI Number | 1992725048
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Entity Type | Individual
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Provider Name | MOHAMMAD IBRAHIM MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 19101 CORTEZ BLVD STE 10065
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3013
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Country | US
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Telephone | 352-325-9294
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Fax | 352-606-5723
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Provider Business Mailing Address
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Address Line | 19101 CORTEZ BLVD STE 10065
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3013
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Country | US
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Telephone | 352-573-0240
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Fax | 352-606-5723
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0095660
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME95660
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License Number State | FL
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