Provider Demographics
NPI:1568463347
Name:ABDO, MOUFID-JOHN H (MD)
Entity Type:Individual
Prefix:DR
First Name:MOUFID-JOHN
Middle Name:H
Last Name:ABDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1901 FLOYD ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2932
Practice Address - Country:US
Practice Address - Phone:941-366-9222
Practice Address - Fax:941-365-2269
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256147207Y00000X
NY001944207Y00000X
FLME130068207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02489554Medicaid
NYDD6674Medicare PIN
H91709Medicare UPIN