1629328786 NPI number — SHERIF SAYED ISMAIL MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629328786 NPI number — SHERIF SAYED ISMAIL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERIF SAYED ISMAIL MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629328786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3201 W GORE BLVD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
LAWTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73505-6378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-510-7077
Provider Business Mailing Address Fax Number:
580-510-7057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 W GORE BLVD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73505-6378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-510-7077
Provider Business Practice Location Address Fax Number:
580-510-7057
Provider Enumeration Date:
09/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ISMAIL
Authorized Official First Name:
SHERIF
Authorized Official Middle Name:
SAYED
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
580-510-7077

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  22720 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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