Provider Demographics
NPI:1003393158
Name:IHIDERO, DAVID IRUOBE (FNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:IRUOBE
Last Name:IHIDERO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7226 WIMBERLY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1587
Mailing Address - Country:US
Mailing Address - Phone:832-656-5099
Mailing Address - Fax:
Practice Address - Street 1:7226 WIMBERLY OAKS LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1587
Practice Address - Country:US
Practice Address - Phone:832-656-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP138033OtherFNP