Basic Information
| Provider Information | |||||||||
| NPI: | 1568443984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABIS | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 BUTLER ST | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334076006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616590770 | ||||||||
| FaxNumber: | 5618023504 | ||||||||
| Practice Location | |||||||||
| Address1: | 2013 PONCE DE LEON AVE | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334076019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616590770 | ||||||||
| FaxNumber: | 5618023504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2005 | ||||||||
| LastUpdateDate: | 05/25/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | ME 57181 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 057828200 | 05 | FL | MEDICAID | 14396 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |