Provider Demographics
NPI:1669417143
Name:ABBOUD, MAZEN A (DPM)
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:A
Last Name:ABBOUD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-780-1255
Mailing Address - Fax:
Practice Address - Street 1:13417 US HIGHWAY 301
Practice Address - Street 2:SUITE B
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5446
Practice Address - Country:US
Practice Address - Phone:813-778-0440
Practice Address - Fax:813-355-5019
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3233213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01170435OtherR&R MEDICARE
FL340592300Medicaid
FL1176890005Medicare NSC
FL1176890004Medicare NSC
FLU7570W - PASCOMedicare PIN
FLP01170435OtherR&R MEDICARE