Provider Demographics
NPI:1538240437
Name:OUDEH, IBRAHIM NAIM (MD)
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:NAIM
Last Name:OUDEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 TILGHMAN DR STE A
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4958
Mailing Address - Country:US
Mailing Address - Phone:910-892-6500
Mailing Address - Fax:910-892-1031
Practice Address - Street 1:801 TILGHMAN DR STE A
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4958
Practice Address - Country:US
Practice Address - Phone:910-892-6500
Practice Address - Fax:910-892-1031
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34428207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011KYMedicaid
NC011KYOtherBLUE CROSS BLUE SHIELD
NC89011KYMedicaid
NC011KYOtherBLUE CROSS BLUE SHIELD