Provider Demographics
NPI:1881633030
Name:ABBOT, STEWART M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:M
Last Name:ABBOT
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 1:1811 GLENMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5245
Mailing Address - Country:US
Mailing Address - Phone:970-351-7664
Mailing Address - Fax:
Practice Address - Street 1:1811 GLENMERE BLVD
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5245
Practice Address - Country:US
Practice Address - Phone:970-351-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27365207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01273655Medicaid
CO314415YLB8Medicare PIN
D24928Medicare UPIN
CO01273655Medicaid