Provider Demographics
NPI:1578727970
Name:MABUS, ALLISON H (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:H
Last Name:MABUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 COUNTY ROAD 210 W.
Mailing Address - Street 2:SUITE 122
Mailing Address - City:FRUITE COVE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4080
Mailing Address - Country:US
Mailing Address - Phone:904-450-8120
Mailing Address - Fax:904-450-8119
Practice Address - Street 1:2851 COUNTY ROAD 210 W.
Practice Address - Street 2:SUITE 122
Practice Address - City:FRUITE COVE
Practice Address - State:FL
Practice Address - Zip Code:32259-4080
Practice Address - Country:US
Practice Address - Phone:904-450-8120
Practice Address - Fax:904-450-8119
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN 13081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine