Healthcare Provider Details

I. General information

NPI: 1407843873
Provider Name (Legal Business Name): AMBROSE ABOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N OREGON ST SUITE 500
EL PASO TX
79902-3351
US

IV. Provider business mailing address

1900 N OREGON ST SUITE 500
EL PASO TX
79902-3351
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-8844
  • Fax: 915-544-7650
Mailing address:
  • Phone: 915-544-8844
  • Fax: 915-544-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberF9119
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: