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NPI Code Detail

MEDICARE: DR. GEORGE WISDOM ABATSO MD

MEDICARE: DR. GEORGE WISDOM ABATSO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianG9411TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
182415KOTHERTXBCBS

General Provider Information

NPI Number : 1265417786
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE WISDOM ABATSO MD
Provider Business Mailing Address
First Line : PO BOX 201606
Second Line :
City : DALLAS
State : TX
Zip : 75320-1606
Country : US
Telephone Number : 972-758-3523
Fax Number :
Provider Business Practice Location Address
First Line : 3301 MATLOCK RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76015-2908
Country : US
Telephone Number : 972-758-3523
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 07/08/2007

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Directions to “ DR. GEORGE WISDOM ABATSO MD” Practice Location

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