Provider Demographics
NPI:1376986224
Name:ABBUBACCA PARKINSON, DPM, PA
Entity Type:Organization
Organization Name:ABBUBACCA PARKINSON, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBUBACCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-273-8624
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33929-1330
Mailing Address - Country:US
Mailing Address - Phone:239-273-8624
Mailing Address - Fax:239-437-4237
Practice Address - Street 1:6 NW 35TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-6932
Practice Address - Country:US
Practice Address - Phone:239-273-8624
Practice Address - Fax:239-437-4237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2944213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340205300Medicaid
FLHC846AMedicare PIN
FL871820001Medicare UPIN
FL340205300Medicaid
FL480034915Medicare PIN