# AHMAD TARIQ ISMAIL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952697575
- **Authorized official:** MISS CAROL L CURRY (OFFICE MANAGER)
- **Authorized official phone:** (850) 547-4799

## Contact information

- **Practice address:** 110 E BYRD AVE, BONIFAY, FL 32425-3004
- **Practice address phone:** (850) 547-4799
- **Practice address fax:** (850) 547-2305
- **Mailing address:** 110 E BYRD AVE, BONIFAY, FL 32425-3004
- **Mailing address phone:** (850) 547-4799
- **Mailing address fax:** (850) 547-2305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | ME44907 | FL | Yes |

## Other

- **Enumeration date:** 06/22/2011
- **Last updated:** 06/22/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 66005600 | — | FL |