Individual
DR. IZZUDDIN ALI MANSUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
49 CLEVELAND ST, SUITE 220, CROSSVILLE, TN 38555-2855
(931) 707-8050
(931) 707-8048
Mailing address
49 CLEVELAND ST, SUITE 220, CROSSVILLE, TN 38555-2855
(931) 707-8050
(931) 707-8048
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD30604
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q063406
—
TN
Enumeration date
04/05/2006
Last updated
06/14/2021
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