Provider Demographics
NPI:1831706985
Name:ABDUL HADI, THAER AHMAD IBRAHIM (MBBS, MD)
Entity type:Individual
Prefix:
First Name:THAER
Middle Name:AHMAD IBRAHIM
Last Name:ABDUL HADI
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5375 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8725
Mailing Address - Country:US
Mailing Address - Phone:850-941-7842
Mailing Address - Fax:850-332-0155
Practice Address - Street 1:5375 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8725
Practice Address - Country:US
Practice Address - Phone:850-941-7842
Practice Address - Fax:850-332-0155
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN32024208000000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics