Individual
AHMAD TARIQ ISMAIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 EAST BYRD AVE, BONIFAY, FL 32425
(850) 547-4799
(850) 547-2305
Mailing address
110 EAST BYRD AVE, BONIFAY, FL 32425
(850) 547-4799
(850) 547-2305
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME44907
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043432900
—
FL
01
—
46198
BCBS
FL
05
—
660056500
—
FL
Enumeration date
11/30/2006
Last updated
01/14/2014
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