Provider Demographics
NPI:1083065148
Name:ABOOD, WALEED RAHEEM ABOOD (MD)
Entity Type:Individual
Prefix:
First Name:WALEED RAHEEM ABOOD
Middle Name:
Last Name:ABOOD
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 1:1 HOSPITAL DRIVE, STE 507
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202
Mailing Address - Country:US
Mailing Address - Phone:573-882-1515
Mailing Address - Fax:573-884-0070
Practice Address - Street 1:1 HOSPITAL DRIVE, STE 507
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202
Practice Address - Country:US
Practice Address - Phone:573-882-1515
Practice Address - Fax:573-884-0070
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160175562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016017556OtherMISSOURI TEMPORARY LICENSE