Healthcare Provider Details

I. General information

NPI: 1801404413
Provider Name (Legal Business Name): ABIDA POOVATHUKARAN BABU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 23 1/2 RD STE 201
GRAND JUNCTION CO
81505-8904
US

IV. Provider business mailing address

PO BOX 1687
GRAND JUNCTION CO
81502-1687
US

V. Phone/Fax

Practice location:
  • Phone: 970-254-3180
  • Fax: 970-254-3198
Mailing address:
  • Phone: 970-257-6200
  • Fax: 970-257-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberDR.0076736
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: