Provider Demographics
NPI:1073870440
Name:EBRAHIM, VIVIAN SAMI (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:SAMI
Last Name:EBRAHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2108
Mailing Address - Country:US
Mailing Address - Phone:903-558-2222
Mailing Address - Fax:903-558-2225
Practice Address - Street 1:1216 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2108
Practice Address - Country:US
Practice Address - Phone:903-558-2222
Practice Address - Fax:903-558-2225
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4961207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology