Individual
MOHAMMAD TAHA IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0404
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
DR.0068079
CO
2085R0202X
Diagnostic Radiology Physician
DR.0068079
CO
2085R0202X
Diagnostic Radiology Physician
Primary
U1513
TX
2085R0204X
Vascular & Interventional Radiology Physician
DR.0068079
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2017
Last updated
08/15/2024
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