Provider Demographics
NPI:1679532451
Name:EBRAHIM, MOUSHIRA ANWAR (MD)
Entity Type:Individual
Prefix:
First Name:MOUSHIRA
Middle Name:ANWAR
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:PO BOX 1888
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1888
Mailing Address - Country:US
Mailing Address - Phone:903-455-4051
Mailing Address - Fax:903-454-1716
Practice Address - Street 1:4215 JOE RAMSEY BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401
Practice Address - Country:US
Practice Address - Phone:903-455-4051
Practice Address - Fax:903-454-1716
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3401207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
81P919Medicare ID - Type Unspecified
G31953Medicare UPIN