Provider Demographics
NPI:1770546921
Name:EL NIHUM, IBRAHIM MUFTAH (MD)
Entity type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:MUFTAH
Last Name:EL NIHUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IBRAHIM
Other - Middle Name:M
Other - Last Name:ELNIHUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:979-696-2422
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6811207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K7731OtherBLUE CROSS
TX105208603Medicaid
TXP00351065Medicare PIN
TXF28747Medicare UPIN
TX8K7731OtherBLUE CROSS