Provider Demographics
NPI:1255540936
Name:ABBOTT, JOHN KEITH III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KEITH
Last Name:ABBOTT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7501 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-9322
Mailing Address - Country:US
Mailing Address - Phone:972-412-7700
Mailing Address - Fax:972-412-7710
Practice Address - Street 1:7501 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 270
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-9322
Practice Address - Country:US
Practice Address - Phone:972-412-7700
Practice Address - Fax:972-412-7710
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2011-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM9766208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L14228Medicare PIN
TX8L14290Medicare PIN
TX8L14220Medicare PIN