Provider Demographics
NPI:1952587503
Name:NOUH, AMER BADREDEN (MD,)
Entity Type:Individual
Prefix:
First Name:AMER
Middle Name:BADREDEN
Last Name:NOUH
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 1:1417 NW 150TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1305
Mailing Address - Country:US
Mailing Address - Phone:405-418-4041
Mailing Address - Fax:
Practice Address - Street 1:1417 NW 150TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1305
Practice Address - Country:US
Practice Address - Phone:405-418-4014
Practice Address - Fax:405-418-4136
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4332722084N0400X
IAR-82492084N0400X
OK27605208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200312230AMedicaid