Healthcare Provider Details

I. General information

NPI: 1326415365
Provider Name (Legal Business Name): MAHMOUD M ISMAIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE
RIO RANCHO NM
87124-3392
US

IV. Provider business mailing address

2400 UNSER BLVD SE
RIO RANCHO NM
87124-3392
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-7878
  • Fax: 505-272-6692
Mailing address:
  • Phone: 505-253-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberMD2019-1040
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2019-1040
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: