Provider Demographics
NPI:1437158938
Name:ABOUD, DWAYNE MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:MITCHELL
Last Name:ABOUD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:154 N FESTIVAL DR
Mailing Address - Street 2:VILLA G
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6266
Mailing Address - Country:US
Mailing Address - Phone:915-845-4024
Mailing Address - Fax:915-845-4019
Practice Address - Street 1:154 N FESTIVAL DR
Practice Address - Street 2:VILLA G
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6266
Practice Address - Country:US
Practice Address - Phone:915-845-4024
Practice Address - Fax:915-845-4019
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF5137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP085Y0902Medicaid
TXB20760Medicare UPIN
TX85Y090Medicare PIN