MEDICARE: DR. MARCUS G ABADIE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G3099	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80F786	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1104821107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS G ABADIE M.D.

Provider Business Mailing Address
First Line	:	117 MEDICAL CIRCLE
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751
Country	:	US
Telephone Number	:	903-676-3200
Fax Number	:	903-676-3277

Provider Business Practice Location Address
First Line	:	117 MEDICAL CIRCLE
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751
Country	:	US
Telephone Number	:	903-676-3200
Fax Number	:	903-676-3277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/09/2007

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