Healthcare Provider Details

I. General information

NPI: 1881621241
Provider Name (Legal Business Name): DAVID TERRANCE ABBOTT I PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 SW 59TH ST
OKLAHOMA CITY OK
73119-7026
US

IV. Provider business mailing address

206 STEVE CT
YUKON OK
73099-6549
US

V. Phone/Fax

Practice location:
  • Phone: 405-688-7700
  • Fax:
Mailing address:
  • Phone: 405-831-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA230
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: