Provider Demographics
NPI:1861933715
Name:IBE, REGINALD
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:
Last Name:IBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9894 BISSONNET ST
Mailing Address - Street 2:SUITE 710
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8239
Mailing Address - Country:US
Mailing Address - Phone:281-630-7913
Mailing Address - Fax:
Practice Address - Street 1:9894 BISSONNET ST
Practice Address - Street 2:SUITE 710
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8239
Practice Address - Country:US
Practice Address - Phone:281-630-7913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-12
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker