Healthcare Provider Details

I. General information

NPI: 1871708545
Provider Name (Legal Business Name): ATHEER BALDAWI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 LA CALMA DR STE. 200
AUSTIN TX
78752-3843
US

IV. Provider business mailing address

5615 SHOAL CREEK BLVD
AUSTIN TX
78756-1032
US

V. Phone/Fax

Practice location:
  • Phone: 888-800-8237
  • Fax: 512-452-6685
Mailing address:
  • Phone: 443-653-1443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT188889
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN8479
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: