1609867464 NPI number — NIDAL I DABBASI M.D.

Table of content: NIDAL I DABBASI M.D. (NPI 1609867464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609867464 NPI number — NIDAL I DABBASI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DABBASI
Provider First Name:
NIDAL
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609867464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4346
Provider Second Line Business Mailing Address:
DEPT 216
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77210-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-331-1850
Provider Business Mailing Address Fax Number:
713-521-7710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12951 SOUTH FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77047-1923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-526-5771
Provider Business Practice Location Address Fax Number:
713-526-2036
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  2009036267 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: L1304 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 142172903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142172904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142172905 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300124925 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 112646500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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