MEDICARE: DAVID IRUOBE IHIDERO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP138033	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP138033	OTHER	TX	FNP

General Provider Information

NPI Number	:	1003393158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID IRUOBE IHIDERO FNP

Provider Business Mailing Address
First Line	:	7226 WIMBERLY OAKS LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-1587
Country	:	US
Telephone Number	:	832-656-5099
Fax Number	:

Provider Business Practice Location Address
First Line	:	7226 WIMBERLY OAKS LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-1587
Country	:	US
Telephone Number	:	832-656-5099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2018
Last Update Date	:	11/21/2018

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