Provider Demographics
NPI:1881634103
Name:YOUSUF, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:YOUSUF
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 1:1765 PUTTER LN
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-8899
Mailing Address - Country:US
Mailing Address - Phone:731-285-7999
Mailing Address - Fax:731-285-6917
Practice Address - Street 1:1950 COOK ST
Practice Address - Street 2:SUITE D
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1899
Practice Address - Country:US
Practice Address - Phone:731-285-7999
Practice Address - Fax:731-285-6917
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730733Medicaid
TN3730733Medicaid
TN3730733Medicaid
TNBY3433620OtherDEA