Basic Information
| Provider Information | |||||||||
| NPI: | 1780019026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DISOTUAR ABAD | ||||||||
| FirstName: | RENE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 646 WEST PALM DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330336615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053305393 | ||||||||
| FaxNumber: | 3053301539 | ||||||||
| Practice Location | |||||||||
| Address1: | 2137 W MLK BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138729384 | ||||||||
| FaxNumber: | 8138727637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2013 | ||||||||
| LastUpdateDate: | 09/21/2018 | ||||||||
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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 | 208D00000X | ME130840 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.