Healthcare Provider Details

I. General information

NPI: 1144488834
Provider Name (Legal Business Name): ABBUBACCA PARKINSON, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12811 KENWOOD LN STE 216
FORT MYERS FL
33907-5667
US

IV. Provider business mailing address

PO BOX 1330
ESTERO FL
33928-1330
US

V. Phone/Fax

Practice location:
  • Phone: 239-273-8624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO2944
License Number StateFL

VIII. Authorized Official

Name: DR. ABBUBACCA PARKINSON
Title or Position: DIRECTOR
Credential:
Phone: 239-273-8624