Provider Demographics
NPI:1679874556
Name:TEXAS DIAGNOSTIC LABORATORIES INC
Entity type:Organization
Organization Name:TEXAS DIAGNOSTIC LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:H
Authorized Official - Last Name:BADRAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND, MS
Authorized Official - Phone:512-619-4904
Mailing Address - Street 1:PO BOX 28662
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-8662
Mailing Address - Country:US
Mailing Address - Phone:512-619-4904
Mailing Address - Fax:
Practice Address - Street 1:3303 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4945
Practice Address - Country:US
Practice Address - Phone:512-419-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty