Provider Demographics
NPI:1780019026
Name:DISOTUAR ABAD, RENE E (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:E
Last Name:DISOTUAR ABAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:646 WEST PALM DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6615
Mailing Address - Country:US
Mailing Address - Phone:305-330-5393
Mailing Address - Fax:305-330-1539
Practice Address - Street 1:2137 W MLK BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6511
Practice Address - Country:US
Practice Address - Phone:813-872-9384
Practice Address - Fax:813-872-7637
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2018-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME130840208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice