Provider Demographics
NPI:1114180866
Name:AYOUB, EDMUND JR (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:AYOUB
Suffix:JR
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:P O BOX 3282
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-3282
Mailing Address - Country:US
Mailing Address - Phone:760-327-9400
Mailing Address - Fax:760-327-9384
Practice Address - Street 1:3655 E RAMON RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1150
Practice Address - Country:US
Practice Address - Phone:760-327-9400
Practice Address - Fax:760-327-9384
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine