Provider Demographics
NPI:1992898860
Name:ISLAM, SUMBUL (MD)
Entity type:Individual
Prefix:DR
First Name:SUMBUL
Middle Name:
Last Name:ISLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E TAYLOR ST STE 3011
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2850
Mailing Address - Country:US
Mailing Address - Phone:903-957-0417
Mailing Address - Fax:903-957-0242
Practice Address - Street 1:600 E TAYLOR ST STE 3011
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2850
Practice Address - Country:US
Practice Address - Phone:903-957-0417
Practice Address - Fax:903-957-0242
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3753980-03Medicaid