Provider Demographics
NPI:1174147086
Name:NORTH TEXAS GENERAL SURGERY PLLC
Entity type:Organization
Organization Name:NORTH TEXAS GENERAL SURGERY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:945-205-0333
Mailing Address - Street 1:3208 AMBER WAVES LN
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-1216
Mailing Address - Country:US
Mailing Address - Phone:945-205-0333
Mailing Address - Fax:945-205-0444
Practice Address - Street 1:811 S CENTRAL EXPY STE 103
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7439
Practice Address - Country:US
Practice Address - Phone:945-205-0333
Practice Address - Fax:945-205-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty