Provider Demographics
NPI:1326415365
Name:ISMAIL, MAHMOUD M (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:M
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR COLUMBIA MO 65212
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-2881
Mailing Address - Country:US
Mailing Address - Phone:573-882-1515
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:505-272-6225
Practice Address - Fax:505-272-6692
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-1040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine