Provider Demographics
NPI:1306843602
Name:ABDALLAH, JOSEPH G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8410 DECATUR ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3811
Mailing Address - Country:US
Mailing Address - Phone:303-430-7000
Mailing Address - Fax:303-430-1506
Practice Address - Street 1:8410 DECATUR ST STE 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3811
Practice Address - Country:US
Practice Address - Phone:303-430-7000
Practice Address - Fax:303-430-1506
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0050531207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27029743Medicaid
KS100644700AMedicaid
CO028698OtherKAISER COMMERCIAL NUMBER
CO27029743Medicaid
KS103126Medicare ID - Type Unspecified