Healthcare Provider Details

I. General information

NPI: 1417957366
Provider Name (Legal Business Name): WILLIAM CHARLES ABBOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 MONTGOMERY BLVD. NE
ALBUQUERQUE NM
87109-7719
US

IV. Provider business mailing address

4123 MONTGOMERY BLVD. NE
ALBUQUERQUE NM
87109-7719
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-6742
  • Fax: 505-884-6845
Mailing address:
  • Phone: 505-884-6742
  • Fax: 505-884-6845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number78-99
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: