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General NPI Number Information
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NPI Number | 1104089853
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Entity Type | Organization
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Legal Business Name | EDMUND AYOUB, JR., M.D., INC
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 3655 E RAMON RD
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City | PALM SPRINGS
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State | CA
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Zip | 92264-1150
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Country | US
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Telephone | 760-835-4229
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Fax |
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Provider Business Mailing Address
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Address Line | P O BOX 3282
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City | PALM SPRINGS
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State | CA
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Zip | 92263-3282
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Country | US
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Telephone | 760-327-9400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDMUND AYOUB JR.
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Credential | MD
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Telephone | 760-835-4229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A104389
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License Number State | CA
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