Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 0101254950 | VA |
NPI | 1023379328 |
---|---|
Provider Name | Eric Abdul |
First Address | Fort Stewart, GA 31314-5641 |
Second Address | Fort Stewart, GA 31314-5641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2012 |
Last Update Date | 30/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |