Provider Demographics
NPI:1013997675
Name:ABSTON, PHILLIP A (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:A
Last Name:ABSTON
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 1:1800 15TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4500
Mailing Address - Country:US
Mailing Address - Phone:970-396-2628
Mailing Address - Fax:970-352-4303
Practice Address - Street 1:1800 15TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4500
Practice Address - Country:US
Practice Address - Phone:970-396-2628
Practice Address - Fax:970-352-4303
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33642208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01336429Medicaid
A99397Medicare UPIN
CO01336429Medicaid