Provider Demographics
NPI:1699847244
Name:AL ENEZI, BADER M
Entity Type:Individual
Prefix:
First Name:BADER
Middle Name:M
Last Name:AL ENEZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SARNO RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4938
Mailing Address - Country:US
Mailing Address - Phone:800-348-4565
Mailing Address - Fax:888-468-6511
Practice Address - Street 1:3100 W END AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1320
Practice Address - Country:US
Practice Address - Phone:615-345-5400
Practice Address - Fax:888-468-6511
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04166246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04166OtherAMERICAN BOARD OF SURGICAL ASSISTANTS