Provider Demographics
NPI:1629175914
Name:HANBALI, FADI (MD)
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:HANBALI
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 1:1250 E CLIFF DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4848
Mailing Address - Country:US
Mailing Address - Phone:915-577-7951
Mailing Address - Fax:915-577-7952
Practice Address - Street 1:1250 E CLIFF DR STE 2A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4848
Practice Address - Country:US
Practice Address - Phone:915-577-7951
Practice Address - Fax:915-577-7952
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM1127207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146715105Medicaid
TX8F5838OtherBCBS OF TEXS
TXTXB132058Medicare PIN
TX8F5838OtherBCBS OF TEXS