Provider Demographics
NPI:1396911624
Name:AYOUB, WALAA AYOUB GABRA
Entity type:Individual
Prefix:DR
First Name:WALAA
Middle Name:AYOUB GABRA
Last Name:AYOUB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:ENDOCRINOLOGY DEPT.
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4401
Mailing Address - Fax:859-258-4418
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:ENDOCRINOLOGY DEPT.
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4401
Practice Address - Fax:859-258-4418
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.012693207R00000X
KY46801207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169Medicare PIN