Provider Demographics
NPI:1033007984
Name:MUZAMMAL, ISMA (PA-C)
Entity type:Individual
Prefix:
First Name:ISMA
Middle Name:
Last Name:MUZAMMAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 ASTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73122-1334
Mailing Address - Country:US
Mailing Address - Phone:405-822-2673
Mailing Address - Fax:
Practice Address - Street 1:3112 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73122-1334
Practice Address - Country:US
Practice Address - Phone:405-822-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant