Provider Demographics
NPI:1023237468
Name:IBRAHIM, TOMMY A (MD)
Entity type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:A
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-773-6470
Mailing Address - Fax:405-773-6463
Practice Address - Street 1:5915 W MEMORIAL RD STE 300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2022
Practice Address - Country:US
Practice Address - Phone:405-773-6470
Practice Address - Fax:405-773-6463
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33455207R00000X, 208M00000X
IL036-125907208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist