Provider Demographics
NPI:1508122839
Name:IBRAHIM, MOHAMED ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ALI
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMED
Other - Middle Name:ALI
Other - Last Name:IBRAHIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:301 UNIVERSITY BLVD, GALVESTON, TX 77555
Mailing Address - Street 2:ANESTHESIOLOGY DEPARTMENT
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555
Mailing Address - Country:US
Mailing Address - Phone:409-772-1825
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555
Practice Address - Country:US
Practice Address - Phone:409-772-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR2628207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program