Healthcare Provider Details

I. General information

NPI: 1508818253
Provider Name (Legal Business Name): AHMED IE BADR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 W ORANGE AVE STE 103
ANAHEIM CA
92804-3152
US

IV. Provider business mailing address

PO BOX 2396
ANAHEIM CA
92814-0396
US

V. Phone/Fax

Practice location:
  • Phone: 714-995-2901
  • Fax: 714-995-5474
Mailing address:
  • Phone: 714-995-2901
  • Fax: 714-995-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA46393
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA46393
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA46393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: