Provider Demographics
NPI:1740886886
Name:NIDAL J BADRAN MD PA
Entity type:Organization
Organization Name:NIDAL J BADRAN MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIDAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BADRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-390-9492
Mailing Address - Street 1:7712 ECKHERT RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3008
Mailing Address - Country:US
Mailing Address - Phone:210-520-8060
Mailing Address - Fax:210-520-0696
Practice Address - Street 1:7712 ECKHERT RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3008
Practice Address - Country:US
Practice Address - Phone:210-520-8060
Practice Address - Fax:210-520-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ9616OtherTX LICENSE