Provider Demographics
NPI:1619067295
Name:ABBOTT, BRIAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:ABBOTT
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 1:1012 HAMPTON FALL BLVD APT 931
Mailing Address - Street 2:
Mailing Address - City:BROWNSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35741-8021
Mailing Address - Country:US
Mailing Address - Phone:970-236-6484
Mailing Address - Fax:
Practice Address - Street 1:1012 HAMPTON FALL BLVD APT 931
Practice Address - Street 2:
Practice Address - City:BROWNSBORO
Practice Address - State:AL
Practice Address - Zip Code:35741-8021
Practice Address - Country:US
Practice Address - Phone:970-236-6484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34561207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1619067295Medicaid
MT0000099035OtherBCBS
MT011002394Medicare PIN
MT011002409Medicare UPIN