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General NPI Number Information
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NPI Number | 1831662568
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Entity Type | Individual
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Provider Name | NIDAL JAMAL BADRAN MD
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Gender | Male
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 06/07/2019
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Provider Practice Location Address
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Address Line | 7712 ECKHERT RD
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City | SAN ANTONIO
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State | TX
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Zip | 78240-3008
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Country | US
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Telephone | 210-520-8060
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Fax |
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Provider Business Mailing Address
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Address Line | 2 ELMWOOD PARK DR APT 225
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City | STATEN ISLAND
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State | NY
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Zip | 10314-7526
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Country | US
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Telephone | 210-390-9492
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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 | 163WH0500X
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Taxonomy Name | Hemodialysis Registered Nurse
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License Number | J9616
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | J9616
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License Number State | TX
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