Provider Demographics
NPI:1053679019
Name:NATH, AUDREY ROSA (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ROSA
Last Name:NATH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 650859 DEPT 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-4021
Mailing Address - Country:US
Mailing Address - Phone:409-772-8053
Mailing Address - Fax:409-772-1084
Practice Address - Street 1:1005 HARBORSIDE DR 6TH FLOOR
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-2358
Practice Address - Country:US
Practice Address - Phone:832-505-2450
Practice Address - Fax:409-747-0777
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2022-09-21
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Provider Licenses
StateLicense IDTaxonomies
TXR94052084N0402X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology