Provider Demographics
NPI:1619083326
Name:ABDO, ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:ABDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2698 N GALLOWAY AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6383
Mailing Address - Country:US
Mailing Address - Phone:972-613-4488
Mailing Address - Fax:972-613-1975
Practice Address - Street 1:2698 N GALLOWAY AVE
Practice Address - Street 2:STE 105
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6383
Practice Address - Country:US
Practice Address - Phone:972-613-4488
Practice Address - Fax:972-613-1975
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG0647207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC12566Medicare UPIN
00A96CMedicare PIN