Provider Demographics
NPI:1588666010
Name:ALI, SOLOMON (MD)
Entity Type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:
Last Name:ALI
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 548
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-0548
Mailing Address - Country:US
Mailing Address - Phone:580-227-2585
Mailing Address - Fax:580-227-2882
Practice Address - Street 1:519 E STATE RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-1458
Practice Address - Country:US
Practice Address - Phone:580-227-2585
Practice Address - Fax:580-227-2882
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23182208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100012520BMedicaid
P00063309Medicare PIN
OKH49004Medicare UPIN