Provider Demographics
NPI:1609865534
Name:HADDAD UROLOGY CLINIC, P.A.
Entity Type:Organization
Organization Name:HADDAD UROLOGY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:I
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-714-4600
Mailing Address - Street 1:1501 W 11TH PL
Mailing Address - Street 2:SUITE103
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-4119
Mailing Address - Country:US
Mailing Address - Phone:432-714-4600
Mailing Address - Fax:432-714-4604
Practice Address - Street 1:1501 W 11TH PL
Practice Address - Street 2:SUITE103
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4119
Practice Address - Country:US
Practice Address - Phone:432-714-4600
Practice Address - Fax:432-714-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8503208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160460501Medicaid
0072JYOtherBCBS OF TEXAS
0072JYOtherBCBS OF TEXAS
TXC16423Medicare UPIN