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NPI Code Detail

MEDICARE: MR. DAVID TERRANCE ABBOTT I PA

MEDICARE: MR. DAVID TERRANCE ABBOTT I PA
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
1363A00000XPhysician AssistantPA230OK

General Provider Information

NPI Number : 1881621241
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID TERRANCE ABBOTT I PA
Provider Business Mailing Address
First Line : 206 STEVE CT
Second Line :
City : YUKON
State : OK
Zip : 73099-6549
Country : US
Telephone Number : 405-831-5698
Fax Number :
Provider Business Practice Location Address
First Line : 2225 SW 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-7026
Country : US
Telephone Number : 405-688-7700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 07/08/2007

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Directions to “ MR. DAVID TERRANCE ABBOTT I PA” Practice Location

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