MEDICARE: DR. DWAYNE MITCHELL ABOUD MD

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	207R00000X	Internal Medicine Physician	F5137	TX

General Provider Information

NPI Number	:	1437158938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWAYNE MITCHELL ABOUD MD

Provider Business Mailing Address
First Line	:	4687 N MESA ST STE 100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6185
Country	:	US
Telephone Number	:	915-500-4086
Fax Number	:	915-995-4996

Provider Business Practice Location Address
First Line	:	11860 VISTA DEL SOL DR STE 150
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6128
Country	:	US
Telephone Number	:	915-808-4000
Fax Number	:	915-995-4996

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/21/2024

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