Individual
MR. SAMIUL J ISLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3101 MENAUL BLVD NE STE B, ALBUQUERQUE, NM 87107-1872
(505) 842-5151
Mailing address
3101 MENAUL BLVD NE STE B, ALBUQUERQUE, NM 87107-1872
(505) 842-5151
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2018-0027
NM
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44984227
—
NM
Enumeration date
01/31/2018
Last updated
11/18/2022
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