Healthcare Provider Details

I. General information

NPI: 1073598512
Provider Name (Legal Business Name): JARED J ABBOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4637 121ST ST
URBANDALE IA
50323-2311
US

IV. Provider business mailing address

4637 121ST ST
URBANDALE IA
50323-2311
US

V. Phone/Fax

Practice location:
  • Phone: 515-655-7080
  • Fax: 515-655-7090
Mailing address:
  • Phone: 515-655-7080
  • Fax: 515-655-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD-37037
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD-37037
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: