Healthcare Provider Details

I. General information

NPI: 1982997011
Provider Name (Legal Business Name): PAULETTE ISMALIA ABBAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 PARK CENTRAL DR STE 400
DALLAS TX
75251-2116
US

IV. Provider business mailing address

3115 DREXEL DR
DALLAS TX
75205-2910
US

V. Phone/Fax

Practice location:
  • Phone: 214-483-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number558801
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberQ1339
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: