Provider Demographics
NPI:1669485983
Name:ABBOUD, ELIAS HABIB (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:HABIB
Last Name:ABBOUD
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 1:22741 HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-3118
Mailing Address - Country:US
Mailing Address - Phone:662-834-1961
Mailing Address - Fax:662-834-1962
Practice Address - Street 1:22741 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3118
Practice Address - Country:US
Practice Address - Phone:662-834-1961
Practice Address - Fax:662-834-1962
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14192207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS080142886OtherRAILROAD MEDICARE PTAN
MS09807861Medicaid
MS00115622Medicaid
MSBA3204271OtherDEA
MS00115622Medicaid