Provider Demographics
NPI:1831428440
Name:SHERIF, ALI MOHAMED (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:MOHAMED
Last Name:SHERIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:HASSAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2324 W. PIERCE ST.
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220
Mailing Address - Country:US
Mailing Address - Phone:575-628-5051
Mailing Address - Fax:
Practice Address - Street 1:5419 N LOVINGTON HWY STE 2
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9102
Practice Address - Country:US
Practice Address - Phone:575-392-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0190208000000X
VA0101246199208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM94887551Medicaid
NM94887551Medicaid