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General NPI Number Information
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NPI Number | 1932462140
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Entity Type | Individual
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Provider Name | MUSTANSER MAHMOOD BADAR MD, MPH, RPVI
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Gender | Male
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 210 LAKE RD STE 200
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City | LAKE JACKSON
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State | TX
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Zip | 77566-4982
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Country | US
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Telephone | 979-299-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 1638 OWEN DR # 138
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3424
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Country | US
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Telephone | 910-615-5095
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Fax | 910-615-9872
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.129000
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | V7818
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | V7818
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 281990
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License Number State | NY
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