Healthcare Provider Details

I. General information

NPI: 1417505504
Provider Name (Legal Business Name): BADR IBRAHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2019
Last Update Date: 08/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WELCH RD
PALO ALTO CA
94304-1611
US

IV. Provider business mailing address

801 WELCH RD
PALO ALTO CA
94304-1611
US

V. Phone/Fax

Practice location:
  • Phone: 650-505-8221
  • Fax:
Mailing address:
  • Phone: 650-724-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA163434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: