Provider Demographics
NPI:1508818253
Name:BADR, AHMED IE (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:IE
Last Name:BADR
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:PO BOX 2396
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92814-0396
Mailing Address - Country:US
Mailing Address - Phone:714-995-2901
Mailing Address - Fax:714-995-5474
Practice Address - Street 1:3055 W ORANGE AVE
Practice Address - Street 2:STE 103
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3152
Practice Address - Country:US
Practice Address - Phone:714-995-2901
Practice Address - Fax:714-995-5474
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46393207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00294848OtherRAILROAD
CA00A463930Medicaid
CA00A463930Medicaid
CA00A463930Medicare ID - Type UnspecifiedMEDICARE