Provider Demographics
NPI:1700860822
Name:ALI, MAHMOUD ISMAIL (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:ISMAIL
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 1:2810 HIGHWAY 77 STE C
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4498
Mailing Address - Country:US
Mailing Address - Phone:850-818-0250
Mailing Address - Fax:850-818-0450
Practice Address - Street 1:2810 HIGHWAY 77 STE C
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4498
Practice Address - Country:US
Practice Address - Phone:850-818-0250
Practice Address - Fax:850-818-0450
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19091207LP2900X
CAA12287207LP2900X
FLME110173207LP2900X
NJ25MA08875800207LP2900X
ZZMASTER DEGREE207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS19091OtherMS MEDICAL BOARD
MS19091OtherMS MEDICAL BOARD
MS19091OtherMS MEDICAL BOARD