Provider Demographics
NPI:1275724320
Name:BADR, YASER (MD)
Entity Type:Individual
Prefix:DR
First Name:YASER
Middle Name:
Last Name:BADR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 41926
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-0926
Mailing Address - Country:US
Mailing Address - Phone:504-715-7975
Mailing Address - Fax:323-352-3016
Practice Address - Street 1:1500 E CHEVY CHASE DR STE 204
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4152
Practice Address - Country:US
Practice Address - Phone:818-827-3898
Practice Address - Fax:818-827-3897
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAGETP.LSU.N207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA126895Medicaid
CAA126895OtherLIC