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General NPI Number Information
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NPI Number | 1437470382
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Entity Type | Individual
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Provider Name | AMIR ABOUTALEBI M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1707 RIGGINS RD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5317
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Country | US
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Telephone | 850-877-4134
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13834
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City | TALLAHASSEE
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State | FL
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Zip | 32317-3834
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Country | US
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Telephone | 502-056-2328
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Fax | 855-975-0615
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10038239
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | Q0853
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License Number State | TX
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