Provider Demographics
NPI:1679582142
Name:ABBOTT, NORMAN S JR (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:S
Last Name:ABBOTT
Suffix:JR
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 1:4705 ALT 19 STE B
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1424
Mailing Address - Country:US
Mailing Address - Phone:727-935-6477
Mailing Address - Fax:727-935-6478
Practice Address - Street 1:4705 ALT 19 STE B
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1424
Practice Address - Country:US
Practice Address - Phone:727-935-6477
Practice Address - Fax:727-935-6478
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049317207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018842300Medicaid
FL04156RMedicare PIN
FL374636400Medicaid