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General NPI Number Information
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NPI Number | 1295726453
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Entity Type | Individual
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Provider Name | BADRELDIN A IBRAHIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 410 RUIDOSA DOWNS
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City | HELOTES
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State | TX
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Zip | 78023-4608
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Country | US
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Telephone | 210-372-0450
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Fax |
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Provider Business Mailing Address
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Address Line | 410 RUIDOSA DOWNS
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City | HELOTES
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State | TX
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Zip | 78023-4608
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Country | US
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Telephone | 210-372-0450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | M0438
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | M0438
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | DR.0054829
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License Number State | CO
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