Provider Demographics
NPI:1932136173
Name:ABBOTT, DAVID JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOEL
Last Name:ABBOTT
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 1:2525 FOX RUN PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5371
Mailing Address - Country:US
Mailing Address - Phone:605-665-0062
Mailing Address - Fax:605-665-0076
Practice Address - Street 1:2525 FOX RUN PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5371
Practice Address - Country:US
Practice Address - Phone:605-665-0062
Practice Address - Fax:605-665-0076
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22982207Y00000X
SD5042207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6520373Medicaid
NE10025374600Medicaid
SD6520338Medicaid
SD6520374Medicaid
SD6520370Medicaid
SD6520337Medicaid
NE10025151400Medicaid
SD6520336Medicaid
SD6520339Medicaid
SD40437Medicare ID - Type Unspecified
SD6520339Medicaid
SDS101114Medicare PIN
SDH64621Medicare UPIN
SDNA1216003Medicare PIN
NE278156Medicare ID - Type Unspecified