Basic Information
| Provider Information | |||||||||
| NPI: | 1023541109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAYOUMI | ||||||||
| FirstName: | MAHMOUD | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6241 N 27TH AVE APT 214 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850171826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013403646 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6019 WALNUT GROVE RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012263610 | ||||||||
| FaxNumber: | 9012263612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2017 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TP00521 | AZ | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 61454 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.