MEDICARE: EDMUND AYOUB JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A104389	CA

General Provider Information

NPI Number	:	1114180866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMUND AYOUB JR. MD

Provider Business Mailing Address
First Line	:	P O BOX 3282
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92263-3282
Country	:	US
Telephone Number	:	760-327-9400
Fax Number	:	760-327-9384

Provider Business Practice Location Address
First Line	:	3655 E RAMON RD
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1150
Country	:	US
Telephone Number	:	760-327-9400
Fax Number	:	760-327-9384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	08/23/2022

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