Basic Information
| Provider Information | |||||||||
| NPI: | 1033350392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALI | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | YALMAZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1475 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503051475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152474240 | ||||||||
| FaxNumber: | 5152474239 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 NORTH ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178221341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716408 | ||||||||
| FaxNumber: | 5702715845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2009 | ||||||||
| LastUpdateDate: | 08/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 40317 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD.203057 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD-40317 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1809799 | 05 | LA | MEDICAID |