MEDICARE: DR. ALI DHIA IBRAHIM M.D.

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	207L00000X	Anesthesiology Physician	P2680	TX
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	P2680	TX

General Provider Information

NPI Number	:	1780818427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI DHIA IBRAHIM M.D.

Provider Business Mailing Address
First Line	:	11331 JAMES WATT DR BLDG 200
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6401
Country	:	US
Telephone Number	:	915-260-8256
Fax Number	:

Provider Business Practice Location Address
First Line	:	11331 JAMES WATT DR BLDG 200
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6401
Country	:	US
Telephone Number	:	915-260-8256
Fax Number	:

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

Provider Enumeration Date	:	05/10/2009
Last Update Date	:	04/13/2020

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