ABBOTT DERMATOLOGY P C (NPI# 1982658167) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982658167 |
| Entity Type | Organization |
| Organization Name | ABBOTT DERMATOLOGY P C |
| Practice Address |
3500 S Western Ave Oklahoma City OK 73109-2413 |
| Practice Telephone | 4056325565 |
| Practice Fax Number | 4056323538 |
| Mailing Telephone | 4056325565 |
| Mailing Fax Number | 4056323538 |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2007-07-18 |
| Authorized Official Name | DR. CRAIG LEON ABBOTT (PHYSICIAN) |
| Authorized Official Telephone | 4056325565 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
17800 | OK | Allopathic & Osteopathic Physicians |
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
17800 | OK | Allopathic & Osteopathic Physicians |
| N | 207N00000X | Dermatology | 17800 | OK | Allopathic & Osteopathic Physicians |
| Y | 207ND0900X |
Dermatology Specialization: Dermatopathology |
17800 | OK | Allopathic & Osteopathic Physicians |
| Street Address |
3500 S WESTERN AVE |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73109-2413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962453795 | Craig Leon Abbott | Dermatology | 3500 S Western Ave, Oklahoma City, OK 73109-2413 | 2006-05-15 |
| 1801061353 | Tara Gleaves | Physician Assistant | 3500 S Western Ave, Oklahoma City, OK 73109-2413 | 2008-04-25 |
| 1306898986 | Randy Ray Bluethman | Physician Assistant | 3500 S Western Ave, Oklahoma City, OK 73109-2413 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063905354 | Housecalls | Family Medicine | 4413 S Lee Ave, Oklahoma City, OK 73109 | 2018-06-11 |
| 1225559404 | John Nathan Jacobsen | Dentist | 235 Sw 25th St., Oklahoma City, OK 73109 | 2017-06-28 |
| 1659828648 | Cynthia Jane Laney | Registered Nurse | 4401 South Western, Oklahoma City, OK 73109 | 2016-09-07 |
| 1497104780 | Hazel Soto | Case Manager/Care Coordinator | 420 Sw, St, Oklahoma, OK 73109 | 2016-06-07 |
| 1063873677 | Ardeceley Brandi Annette Hernandez | Community/Behavioral Health | 5714 S. Western Ave, Oklahoma City, OK 73109 | 2016-03-09 |
| 1316343908 | Van Ngo | Nurse Practitioner | 4413 South Lee Ave, Oklahoma City, OK 73109 | 2014-11-10 |
| 1104249150 | Janessa Ladawn Bointy | Counselor | 5359 S. Western Ave. #707, Oklahoma City, OK 73109 | 2014-01-28 |
| 1033540299 | Bryan Graham | Case Manager/Care Coordinator | 1111 Sw 28th St, Oklahoma City, OK 73109 | 2013-12-12 |
| 1154684603 | Nubia Fiesel | Counselor | 420 Sw 10th Street, Oklahoma City, OK 73109 | 2012-06-20 |
| 1548533664 | C.c. Freeman, Md. Inc | Internal Medicine | 4221 S. Western Ave., Suite 2015, Oklahoma City, OK 73109 | 2012-02-21 |
| Find all providers in zip 73109 | ||||
| Taxonomy Code | 207ND0900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Dermatopathology |
| A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/; American Osteopathic Board of Dermatology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Dermatology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306101894 | Maria Deschaine | Dermatology | 800 Stanton L Young Blvd # 6400, Oklahoma City, OK 73104-5018 | 2012-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407024367 | Paul S. Gillum, Md, PC | Dermatology | 2413 Palmer Cir, Norman, OK 73069-6301 | 2008-02-13 |
| City | OKLAHOMA CITY |
| Zip Code | 73109 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.