Healthcare Provider Details

I. General information

NPI: 1386744266
Provider Name (Legal Business Name): AHMAD FARID BADERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 E FLAMINGO RD SUITE # D
LAS VEGAS NV
89121-5200
US

IV. Provider business mailing address

1350 E FLAMINGO RD #174
LAS VEGAS NV
89119-5263
US

V. Phone/Fax

Practice location:
  • Phone: 702-380-2048
  • Fax: 702-968-8637
Mailing address:
  • Phone: 702-380-2048
  • Fax: 702-968-8637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number11481
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11481
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: