Provider Demographics
NPI:1245397744
Name:BADUEL, WINNIFER LOURDES (MD)
Entity Type:Individual
Prefix:DR
First Name:WINNIFER
Middle Name:LOURDES
Last Name:BADUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 MEDICAL DR
Mailing Address - Street 2:STE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3342
Mailing Address - Country:US
Mailing Address - Phone:210-732-3668
Mailing Address - Fax:210-732-3338
Practice Address - Street 1:4330 MEDICAL DR
Practice Address - Street 2:STE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3342
Practice Address - Country:US
Practice Address - Phone:210-732-3668
Practice Address - Fax:210-732-3338
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096250801Medicaid
TX8W9002OtherBLUE CROSS BLUE SHIELD
TX096250801Medicaid
TX8K7346Medicare PIN
TX0003BAMedicare ID - Type Unspecified