Provider Demographics
NPI:1073626198
Name:BADRA, DINA ANTOUN (MD)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:ANTOUN
Last Name:BADRA
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 1:15539 MONTEROSSO LN
Mailing Address - Street 2:#201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-2742
Mailing Address - Country:US
Mailing Address - Phone:239-514-8787
Mailing Address - Fax:239-514-1965
Practice Address - Street 1:9160 GALLERIA CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4343
Practice Address - Country:US
Practice Address - Phone:239-514-8787
Practice Address - Fax:239-514-1965
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065421208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37654820Medicaid
FL37654820Medicaid