Provider Demographics
NPI:1174570790
Name:VIOLETA BADDOUR MD, PA
Entity type:Organization
Organization Name:VIOLETA BADDOUR MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIOLETA
Authorized Official - Middle Name:BADDOUR
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-569-4077
Mailing Address - Street 1:PO BOX 3851
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-3851
Mailing Address - Country:US
Mailing Address - Phone:830-569-4077
Mailing Address - Fax:830-569-5679
Practice Address - Street 1:1850 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2325
Practice Address - Country:US
Practice Address - Phone:325-670-4590
Practice Address - Fax:325-670-4587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7242207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00066XOtherMEDICARE
TX1665515Medicaid
TX45D1029696OtherCLIA
00066XOtherMEDICARE
H39971Medicare UPIN
00066XMedicare PIN