Provider Demographics
NPI:1659594752
Name:IBRAHEIM, NASHAAT BOTROUS (MD)
Entity Type:Individual
Prefix:
First Name:NASHAAT
Middle Name:BOTROUS
Last Name:IBRAHEIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 RICHMOND AVE
Mailing Address - Street 2:SUITE 412
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2437
Mailing Address - Country:US
Mailing Address - Phone:281-558-5656
Mailing Address - Fax:281-558-5667
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE 412
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2437
Practice Address - Country:US
Practice Address - Phone:281-558-5656
Practice Address - Fax:281-558-5667
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157198601Medicaid
TX157198601Medicaid