Provider Demographics
NPI:1356319776
Name:HABABAG, MANUEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:B
Last Name:HABABAG
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 1:3321 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630
Mailing Address - Country:US
Mailing Address - Phone:409-883-6052
Mailing Address - Fax:409-883-9620
Practice Address - Street 1:3321 RIDGEMONT DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630
Practice Address - Country:US
Practice Address - Phone:409-883-6052
Practice Address - Fax:409-883-9620
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133123303Medicaid
TXTXB127206OtherMEDICARE PTAN
A76945Medicare UPIN