Provider Demographics
NPI:1639373731
Name:IBAZEBO, EHIREME ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:EHIREME
Middle Name:ANTHONY
Last Name:IBAZEBO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2300 MCDERMOTT RD
Mailing Address - Street 2:SUITE 200-349
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-7016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 N STEMMONS FWY
Practice Address - Street 2:SUITE 151
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2113
Practice Address - Country:US
Practice Address - Phone:214-905-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1566332084P0800X
TXK95712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H18400Medicare UPIN