Healthcare Provider Details

I. General information

NPI: 1356082002
Provider Name (Legal Business Name): AL ANOUD DAOUD BADDOUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N MEDICAL DR E RM 5675
SALT LAKE CITY UT
84132-0002
US

IV. Provider business mailing address

6431 FANNIN ST
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 713-500-6128
  • Fax: 713-500-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10096347
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number13502720-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: