Basic Information
| Provider Information | |||||||||
| NPI: | 1003996521 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISOM | ||||||||
| FirstName: | ADOLPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 51254 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900515554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143170600 | ||||||||
| FaxNumber: | 3143170606 | ||||||||
| Practice Location | |||||||||
| Address1: | 3280 DAUPHIN ST | ||||||||
| Address2: | BUILDING B, SUITE 118 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366064060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514544579 | ||||||||
| FaxNumber: | 2512871466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 12/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD.14341 | AL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 009933259 | 05 | AL | MEDICAID | 009936127 | 05 | AL | MEDICAID | 009936128 | 05 | AL | MEDICAID | 009936129 | 05 | AL | MEDICAID | 146753 | 05 | AL | MEDICAID |