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Provider Information for 1063472108

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

RICHARD VICTOR ABDO MD

Gender: MALE

Individual NPI: 1063472108

Calendar   Last Updated:  2019-05-27
  Certification Date: 

Details

Name Value
NPI 1063472108
Enumeration Date 2006-03-24
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1011 JEFFORDS ST SUITE C
CLEARWATER, FL 33756-4070
United States

Phone: 727-446-5993 | Fax: 727-446-4477
View Map External Link
Primary Practice Address 1011 JEFFORDS ST SUITE C
CLEARWATER, FL 33756-4070
United States

Phone: 727-446-5993 | Fax: 727-446-4477
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID FL 375645900
Other TAX ID NUMBER FL 591306865
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207XX0004X - Orthopaedic Surgery Foot and Ankle Surgery FL ME0066584
No 207X00000X - Orthopaedic Surgery FL ME0066584
No 207XS0114X - Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery FL ME0066584
No 207XX0005X - Orthopaedic Surgery Sports Medicine FL ME0066584