Healthcare Provider Details

I. General information

NPI: 1629328786
Provider Name (Legal Business Name): SHERIF SAYED ISMAIL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W GORE BLVD SUITE 105
LAWTON OK
73505-6378
US

IV. Provider business mailing address

3201 W GORE BLVD SUITE 105
LAWTON OK
73505-6378
US

V. Phone/Fax

Practice location:
  • Phone: 580-510-7077
  • Fax: 580-510-7057
Mailing address:
  • Phone: 580-510-7077
  • Fax: 580-510-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number22720
License Number StateOK

VIII. Authorized Official

Name: DR. SHERIF SAYED ISMAIL
Title or Position: OWNER
Credential: M.D.
Phone: 580-510-7077