Healthcare Provider Details

I. General information

NPI: 1669485983
Provider Name (Legal Business Name): ELIAS HABIB ABBOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22741 HIGHWAY 12
LEXINGTON MS
39095-3118
US

IV. Provider business mailing address

22741 HIGHWAY 12
LEXINGTON MS
39095-3118
US

V. Phone/Fax

Practice location:
  • Phone: 662-834-1961
  • Fax: 662-834-1962
Mailing address:
  • Phone: 662-834-1961
  • Fax: 662-834-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14192
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: