=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093718637
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY C BADOUR DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2005
-----------------------------------------------------
Last Update Date | 04/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 280 COHASSET RD
-----------------------------------------------------
City | CHICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-879-5000
-----------------------------------------------------
Fax | 530-879-5025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 280 COHASSET RD
-----------------------------------------------------
City | CHICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95926-2210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-879-5000
-----------------------------------------------------
Fax | 530-879-5025
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20A8114
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------