Provider Demographics
NPI:1316231566
Name:IBRAHIM, YETUNDE O (MD)
Entity Type:Individual
Prefix:
First Name:YETUNDE
Middle Name:O
Last Name:IBRAHIM
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 1:5757 WARREN PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:972-377-2667
Practice Address - Street 1:5757 WARREN PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4778
Practice Address - Country:US
Practice Address - Phone:561-379-7199
Practice Address - Fax:561-379-7199
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248439207V00000X
TXS1136207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S1136OtherTX LICENSE