Provider Demographics
NPI:1407843873
Name:ABOUD, AMBROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBROSE
Middle Name:
Last Name:ABOUD
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 1:1900 N OREGON ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3351
Mailing Address - Country:US
Mailing Address - Phone:915-544-8844
Mailing Address - Fax:915-544-7650
Practice Address - Street 1:1900 N OREGON ST
Practice Address - Street 2:SUITE 500
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3351
Practice Address - Country:US
Practice Address - Phone:915-544-8844
Practice Address - Fax:915-544-7650
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9119207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000V5525Medicaid
TX098415502Medicaid
TX098415503Medicaid
TXF9119OtherSTATE LICENSE NUMBER
TX89690BMedicare ID - Type Unspecified
TX098415503Medicaid
TX098415502Medicaid