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General NPI Number Information
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NPI Number | 1992795751
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Entity Type | Organization
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Legal Business Name | CRESCENT NEUROLOGY P.A.
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 PEAKWOOD DR SUITE 6-D
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City | HOUSTON
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State | TX
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Zip | 77090-2900
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Country | US
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Telephone | 281-586-8800
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Fax | 281-586-8822
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Provider Business Mailing Address
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Address Line | PO BOX 73829
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City | HOUSTON
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State | TX
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Zip | 77273-3829
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Country | US
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Telephone | 281-586-8800
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Fax | 281-586-8822
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FATIMA IBRAHIM
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Credential | M.D.
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Telephone | 281-586-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | M1780
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License Number State | TX
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