Provider Demographics
NPI:1689662512
Name:HADDAD, RUDY I (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDY
Middle Name:I
Last Name:HADDAD
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 1:1501 W. 11TH PLACE
Mailing Address - Street 2:STE 103
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720
Mailing Address - Country:US
Mailing Address - Phone:432-714-4600
Mailing Address - Fax:432-714-4604
Practice Address - Street 1:1501 W. 11TH PLACE
Practice Address - Street 2:STE 103
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720
Practice Address - Country:US
Practice Address - Phone:432-714-4600
Practice Address - Fax:432-714-4604
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8503208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8J0840OtherBCBS
TX132906209Medicaid
8J0840OtherBCBS
TX132906209Medicaid
C16423Medicare UPIN