Provider Demographics
NPI:1982233854
Name:IYEGHA, IBASARABOH (MD)
Entity Type:Individual
Prefix:
First Name:IBASARABOH
Middle Name:
Last Name:IYEGHA
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 1:4461 COIT RD STE 405
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0531
Mailing Address - Country:US
Mailing Address - Phone:972-526-0700
Mailing Address - Fax:
Practice Address - Street 1:4461 COIT RD STE 405
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0531
Practice Address - Country:US
Practice Address - Phone:972-516-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU2230208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics