MEDICARE: JOHN PHILLIP ABBOTT D.O.

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	29346	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255477790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PHILLIP ABBOTT D.O.

Provider Business Mailing Address
First Line	:	310 EAST OLIVE STREET
Second Line	:
City	:	LAMAR
State	:	CO
Zip	:	81052-2841
Country	:	US
Telephone Number	:	719-931-9844
Fax Number	:	719-931-8007

Provider Business Practice Location Address
First Line	:	310 EAST OLIVE STREET
Second Line	:
City	:	LAMAR
State	:	CO
Zip	:	81052-2841
Country	:	US
Telephone Number	:	719-931-9844
Fax Number	:	719-931-8007

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	11/04/2024

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