Healthcare Provider Details

I. General information

NPI: 1376544106
Provider Name (Legal Business Name): PAUL ABIDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 S RANGE AVE
DENHAM SPRINGS LA
70726-5201
US

IV. Provider business mailing address

DEPT 960139
OKLAHOMA CITY OK
73196-0001
US

V. Phone/Fax

Practice location:
  • Phone: 225-791-0002
  • Fax: 225-791-0228
Mailing address:
  • Phone: 877-485-4474
  • Fax: 405-844-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16898
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: