Provider Demographics
NPI:1467461541
Name:PARKINSON, ABBUBACCA T (DPM)
Entity Type:Individual
Prefix:DR
First Name:ABBUBACCA
Middle Name:T
Last Name:PARKINSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2944213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340205300Medicaid
FL65721Medicare PIN
FL480034915Medicare PIN
FL871820001Medicare UPIN
FL340205300Medicaid