Basic Information
| Provider Information | |||||||||
| NPI: | 1528167947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISMAIL | ||||||||
| FirstName: | AYAAZ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7150 SMOKE RANCH RD # 110 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891283157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5209489480 | ||||||||
| FaxNumber: | 7024855101 | ||||||||
| Practice Location | |||||||||
| Address1: | 7150 SMOKE RANCH RD # 110 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891283157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029489480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 01/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 29921 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 16970 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 642365 | 05 | AZ | MEDICAID | 100015863 | 01 | AZ | RR MEDICARE | OTHER | 1528167947 | 01 | AZ | INDIVIDUAL | OTHER |