MEDICARE: DR. ABUBAKAR DENJA IBRAHIM MD

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	207Q00000X	Family Medicine Physician	027065	LA
2	207P00000X	Emergency Medicine Physician	027065	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942248059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABUBAKAR DENJA IBRAHIM MD

Provider Business Mailing Address
First Line	:	6821 PINES RD STE 300
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-2547
Country	:	US
Telephone Number	:	318-686-1522
Fax Number	:	318-686-5101

Provider Business Practice Location Address
First Line	:	6821 PINES RD STE 300
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-2547
Country	:	US
Telephone Number	:	318-686-1522
Fax Number	:	318-686-5101

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	11/13/2025

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