Provider Demographics
NPI:1700572419
Name:ABDEEN, COREY R (DO)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:R
Last Name:ABDEEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 ROBIN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5845
Mailing Address - Country:US
Mailing Address - Phone:601-750-1226
Mailing Address - Fax:
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:GRADUATE MEDICAL EDUCATION RESEARCH WING, R102
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-3921
Practice Address - Country:US
Practice Address - Phone:601-984-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS390200000X
MST-5031207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program