Provider Demographics
NPI:1407067911
Name:ABELDT, JEFFREY V
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:V
Last Name:ABELDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W RUSK ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1513
Mailing Address - Country:US
Mailing Address - Phone:903-533-8155
Mailing Address - Fax:903-533-8158
Practice Address - Street 1:314 W RUSK ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1513
Practice Address - Country:US
Practice Address - Phone:903-533-8155
Practice Address - Fax:903-533-8158
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPH0600Medicare ID - Type UnspecifiedMEDICARE PART B