Provider Demographics
NPI:1033146691
Name:BADDOURA, NAJI KAMAL (M D)
Entity type:Individual
Prefix:DR
First Name:NAJI
Middle Name:KAMAL
Last Name:BADDOURA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14434 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2612
Mailing Address - Country:US
Mailing Address - Phone:813-971-1010
Mailing Address - Fax:813-632-8670
Practice Address - Street 1:14434 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2612
Practice Address - Country:US
Practice Address - Phone:813-971-1010
Practice Address - Fax:813-632-8670
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72028208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1738245OtherFIRST HEALTH
FL2572044014Medicaid
FL265200OtherAVMED
FL1300076OtherUNITED HEALTHCARE
FL32724OtherBC/BS
FL7698018OtherAETNA
FL27567OtherWELLCARE
FL8759380OtherCIGNA
FL7698018OtherAETNA
FL32424AMedicare ID - Type Unspecified