Provider Demographics
NPI:1720020878
Name:HABASH, NABIL ANTON (MD)
Entity type:Individual
Prefix:
First Name:NABIL
Middle Name:ANTON
Last Name:HABASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190922
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-0922
Mailing Address - Country:US
Mailing Address - Phone:512-763-4545
Mailing Address - Fax:512-763-4546
Practice Address - Street 1:1250 8TH AVE STE 265
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4124
Practice Address - Country:US
Practice Address - Phone:682-200-8580
Practice Address - Fax:682-200-8581
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086203208200000X, 208600000X
TXN63342086S0122X, 208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2638524Medicaid
TXTXB164394Medicare PIN