Provider Demographics
NPI:1669407516
Name:HAWATMEH, IBRAHIM SALIM (MD)
Entity type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:SALIM
Last Name:HAWATMEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ABRAHAM
Other - Middle Name:SALIM
Other - Last Name:HAWATMEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12345 W BEND DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2104
Mailing Address - Country:US
Mailing Address - Phone:314-843-8000
Mailing Address - Fax:314-843-3004
Practice Address - Street 1:12345 W BEND DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2104
Practice Address - Country:US
Practice Address - Phone:314-843-8000
Practice Address - Fax:314-843-3004
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35812208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001010433Medicare PIN
MOE12109Medicare UPIN