NPIMap

Organization Active NPI

Ihab John Ibrahim MD LLC

  • Interventional Pain Medicine Physician
  • Shreveport, LA
National Provider Identifier
1699283804
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
MD.14699R Issued in LA
Legal business name
IHAB JOHN IBRAHIM MD LLC
Practice address
672 Bert Kouns Industrial Loop
Shreveport, LA 71118-5701
Phone
(318) 572-2067
Fax
(318) 572-2067
NPI assigned
Jan 22, 2018
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ihab John Ibrahim, MD
Title
Sole Owner
Phone
(318) 572-2067

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD.14699R LA
Physical Medicine & Rehabilitation Physician 208100000X MD.14699R LA
Interventional Pain Medicine Physician 208VP0014X MD.14699R LA Primary

Addresses

Primary practice location

672 Bert Kouns Industrial Loop
Shreveport, LA 71118-5701

Mailing address

635 Summerville Dr
Shreveport, LA 71115-3865
Phone (318) 572-2067

National Provider Directory

National Provider Directory

Locations

672 Bert Kouns Industrial Loop
Shreveport, LA 71118
Phone (318) 572-2067

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1699283804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 SUMMERVILLE DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711153865",
            "telephone_number": "318-572-2067",
            "fax_number": "877-991-8458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "672 BERT KOUNS INDUSTRIAL LOOP",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711185701",
            "telephone_number": "318-572-2067",
            "fax_number": "318-572-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IHAB JOHN IBRAHIM MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-22",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "IHAB",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "318-572-2067",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "MD.14699R",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "LA",
            "license": "MD.14699R",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "LA",
            "license": "MD.14699R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.