Provider Demographics
NPI:1043292915
Name:NATHAN, HABIB (MD)
Entity type:Individual
Prefix:
First Name:HABIB
Middle Name:
Last Name:NATHAN
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 1:9480 HUEBNER RD
Mailing Address - Street 2:# 210
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1657
Mailing Address - Country:US
Mailing Address - Phone:210-614-9595
Mailing Address - Fax:210-615-7362
Practice Address - Street 1:9480 HUEBNER RD
Practice Address - Street 2:# 210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1657
Practice Address - Country:US
Practice Address - Phone:210-614-9595
Practice Address - Fax:210-615-7362
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD66012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099665401Medicaid
TX80009103OtherCONTROLLED SUBSTANCE
TXD6601OtherM.D. LICENSE
TXD6601OtherM.D. LICENSE
TXOOP267Medicare ID - Type UnspecifiedMEDICARE
TX099665401Medicaid