Provider Demographics
NPI:1720213101
Name:ABBOTT, JOEL EMMANUEL (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:EMMANUEL
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 S PECOS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5039
Mailing Address - Country:US
Mailing Address - Phone:725-225-5575
Mailing Address - Fax:833-941-2450
Practice Address - Street 1:4425 S PECOS RD STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5039
Practice Address - Country:US
Practice Address - Phone:725-225-5575
Practice Address - Fax:833-941-2450
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11538208800000X
NVDO2639208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD108538700Medicaid
MD108538700Medicaid