Provider Demographics
NPI:1003996521
Name:ISOM, ADOLPH (MD)
Entity Type:Individual
Prefix:
First Name:ADOLPH
Middle Name:
Last Name:ISOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51254
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5554
Mailing Address - Country:US
Mailing Address - Phone:314-317-0600
Mailing Address - Fax:314-317-0606
Practice Address - Street 1:3280 DAUPHIN ST
Practice Address - Street 2:BUILDING B, SUITE 118
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4060
Practice Address - Country:US
Practice Address - Phone:251-454-4579
Practice Address - Fax:251-287-1466
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.14341208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933259Medicaid
AL009936127Medicaid
AL009936128Medicaid
AL009936129Medicaid
AL146753Medicaid
ALP00258794Medicare PIN
AL051556811Medicare PIN
AL009936129Medicaid
AL009936127Medicaid