Healthcare Provider Details

I. General information

NPI: 1003996521
Provider Name (Legal Business Name): ADOLPH ISOM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 DAUPHIN ST BUILDING B, SUITE 118
MOBILE AL
36606-4060
US

IV. Provider business mailing address

PO BOX 51254
LOS ANGELES CA
90051-5554
US

V. Phone/Fax

Practice location:
  • Phone: 251-454-4579
  • Fax: 251-287-1466
Mailing address:
  • Phone: 314-317-0600
  • Fax: 314-317-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.14341
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: