Provider Demographics
NPI:1720217995
Name:ELMAGBOUL, NADA (MD)
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:ELMAGBOUL
Suffix:
Gender:F
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 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:BAYLOR SCOTT AND WHITE CLINIC
Practice Address - Street 2:425 UNIVERSITY BOULEVARD
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665
Practice Address - Country:US
Practice Address - Phone:512-509-0200
Practice Address - Fax:512-509-0285
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD35133207RR0500X
TXS4627207RR0500X
PAMD447077207R00000X
TN49785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200720001Medicaid
TN6002130OtherBCBS
MS08139832Medicaid
TNQ001716Medicaid
TN103I115969Medicare PIN