Provider Demographics
NPI:1083059257
Name:BADOGHAISH, WALEED OMAR (MD)
Entity Type:Individual
Prefix:
First Name:WALEED
Middle Name:OMAR
Last Name:BADOGHAISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 RESERVOIR RD, NW
Mailing Address - Street 2:INTERNAL MEDICINE /GASTROENTEROLOGY
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007
Mailing Address - Country:US
Mailing Address - Phone:202-444-4034
Mailing Address - Fax:202-444-7797
Practice Address - Street 1:1400 S COULTER ST
Practice Address - Street 2:UNIT MANAGER FOR GME, TTUHSC
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-354-5417
Practice Address - Fax:806-351-3787
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ1002215125390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program