Provider Demographics
NPI:1770531469
Name:VALDES-MORRIS, IBRAHIM (MD)
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:
Last Name:VALDES-MORRIS
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 1:305 LANGDON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2750
Mailing Address - Country:US
Mailing Address - Phone:606-451-2994
Mailing Address - Fax:606-451-2975
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-313-2963
Practice Address - Fax:859-313-3541
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00471570OtherRAILROAD MEDICARE
KY000000513190OtherANTHEM BCBS
KY000000475573OtherANTHEM
KY64120678Medicaid
KYP400025616Medicare PIN
KY64120678Medicaid
KY0758314Medicare PIN
KY000000475573OtherANTHEM
I48416Medicare UPIN
KYP00879573Medicare PIN