Provider Demographics
NPI:1326668955
Name:ABBOTT, MICHAEL NELSON (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NELSON
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6634 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:LEON VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2140
Mailing Address - Country:US
Mailing Address - Phone:801-717-0392
Mailing Address - Fax:
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10070498390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program