Individual
A.S.M. MANZURUL ISLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 S COULTER ST, AMARILLO, TX 79106-1786
(806) 414-9100
(806) 354-5717
Mailing address
1400 WALLACE BLVD, AMARILLO, TX 79106-1708
(806) 414-9100
(806) 354-5717
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
P5382
TX
390200000X
Student in an Organized Health Care Education/Training Program
550845
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200486640 A
—
OK
05
—
23022728
—
NM
05
—
319239501
—
TX
05
—
319239502
—
TX
Enumeration date
04/27/2010
Last updated
05/06/2016
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