Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 248439 | MA |
Y | 207VE0102X | Reproductive Endocrinologist | S1136 | TX |
NPI | 1316231566 |
---|---|
Provider Name | Yetunde O Ibrahim |
First Address | Frisco, TX 75034-4199 |
Second Address | Frisco, TX 75034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2011 |
Last Update Date | 17/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S1136 | TX LICENSE (01) |