Healthcare Provider Details

I. General information

NPI: 1467415158
Provider Name (Legal Business Name): MOHAMAD JAMIL ALKUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 21ST ST SUITE B
LUBBOCK TX
79410-1011
US

IV. Provider business mailing address

3420 22ND PLACE
LUBBOCK TX
79410
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-4630
  • Fax: 806-723-7809
Mailing address:
  • Phone: 806-725-5844
  • Fax: 806-723-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ6847
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: