Healthcare Provider Details

I. General information

NPI: 1053301697
Provider Name (Legal Business Name): YOUNUS M ISMAIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 S BROAD ST SUITE 200
SCOTTSBORO AL
35768-2667
US

IV. Provider business mailing address

1508 S BROAD ST SUITE 200
SCOTTSBORO AL
35768-2667
US

V. Phone/Fax

Practice location:
  • Phone: 256-259-3778
  • Fax: 256-259-3759
Mailing address:
  • Phone: 256-259-3778
  • Fax: 256-259-3759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22123
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: