JOE DAVID IBANEZ (NPI# 1285669069) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285669069 |
| Entity Type | Individual |
| Full Name | JOE DAVID IBANEZ |
| Credential | M.D. |
| Practice Address |
504 Medical Center Blvd Conroe TX 77304-2808 |
| Mailing Address |
Po Box 4677 Houston TX 77210-4677 |
| Practice Telephone | 7134813544 |
| Practice Fax Number | 7134320221 |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-08-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
E6434 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS | 8DF121 | 01 |
| TX | RAILROAD MEDICARE | P00335704 | 01 |
| TX | 116811404 | 05 | |
| TX | BCBS | 8G9909 | 01 |
| TX | 116811407 | 05 | |
| TX | RAILROAD MEDICARE - WHARTON MEM HERM | P01188589 | 01 |
| TX | TRAVELER'S MEDICARE | 220030493 | 01 |
| TX | BCBS-STMC | 87880J | 01 |
| TX | 116811403 | 05 | |
| TX | MEDICAID STMC | 116811405 | 01 |
| Street Address |
504 MEDICAL CENTER BLVD |
| City | CONROE |
| State | TX |
| Zip Code | 77304-2808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851395214 | Dawna Lavina Armstrong | Pathology | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2005-06-13 |
| 1699384792 | Susan Kae Wooden | Nurse Practitioner | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2020-07-24 |
| 1811522204 | Ashley Hudson | Anesthesiologist Assistant | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2020-03-06 |
| 1609421593 | Ambient Anesthesia | Anesthesiology | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2019-08-07 |
| 1154975233 | Kristina Brown | Dietitian, Registered | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2019-07-28 |
| 1437617768 | Julie M Quinn | Physical Medicine & Rehabilitation | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2019-03-05 |
| 1245798602 | Samuel Loera Diaz | Specialist/Technologist, Other | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2019-03-05 |
| 1144787136 | Leyla Aileen M Lastra | Specialist/Technologist, Other | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2019-02-26 |
| 1619491834 | Edmund Byron Webster Iv | Physician Assistant | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2017-07-30 |
| 1871034488 | Montgomery Orthopedic Care Specialists Pllc | Surgery | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2017-03-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194348649 | Neuropsychiatric Hospital of Greater Houston, LLC | Psychiatric Hospital | 1317 South Loop Road 336 West, Conroe, TX 77304 | 2020-05-19 |
| 1780148676 | Muve - Conroe Ambulatory Surgical Center, LLC | Clinic/Center | 1246 N Farm To Market 3083 Rd W, Conroe, TX 77304 | 2019-01-25 |
| 1922591411 | Bradley Leiker II | Dentist | 381 South Loop 336 West Suite 500, Conroe, TEXAS 77304 | 2018-06-11 |
| 1598266009 | Chapman Pain Consultants | Anesthesiology | 4015 I45 North, Suite 230-1, Conroe, TX 77304 | 2018-02-21 |
| 1063932366 | Jonathan Garcia | Specialist/Technologist | 1716 Summergate Drive, Conroe, TX 77304 | 2017-06-27 |
| 1932634169 | 3083 Imaging LLC | Clinic/Center | 1246 N Fm 3083 West, Conroe, TX 77304 | 2017-04-25 |
| 1881138758 | Bolt Urgent Care and Imaging Center, LLC | Clinic/Center | 1246 Fm 3083 West, Conroe, TX 77304 | 2016-12-13 |
| 1497106272 | The Rio At Conroe, LLC | Skilled Nursing Facility | 604 South Conroe Medical Drive, Conroe, TX 77304 | 2016-06-23 |
| 1093165615 | Melanie Kay Plaster | Behavioral Analyst | 2626 Silver Shadow, Conroe, TX 77304 | 2016-06-14 |
| 1508249798 | Conroe Willis Family Medicine, Pllc | Family Medicine | 4015 I 45 N Ste 220, Conroe, TX 77304 | 2015-07-07 |
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| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679808745 | Baylor Pathology Consultants | Pathology | 500 Medical Center Blvd, Suite 360a, Conroe, TX 77304-2889 | 2009-10-07 |
| 1336386556 | Edward Perez | Pathology | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2009-01-09 |
| 1396847208 | David W. Jackson | Pathology | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2006-09-01 |
| 1700997764 | Bharati Santosh Helekar | Pathology | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2006-08-31 |
| 1346275120 | Maria Ramos | Pathology | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2006-07-11 |
| 1447281951 | Eduardo Brugo | Pathology | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2006-07-05 |
| 1609810696 | Jabeen Fatima Naqvi | Pathology | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2006-06-16 |
| 1316921026 | Baylor College of Medicine | Pathology | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2005-12-06 |
| 1740285352 | Marcia Arlene Barnes | Pathology | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2005-06-20 |
| 1548265507 | Syed Fiaz Quadri | Pathology | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2005-06-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.