Provider Demographics
NPI:1174519771
Name:DAWOD, ABDALLAH S (MD)
Entity type:Individual
Prefix:
First Name:ABDALLAH
Middle Name:S
Last Name:DAWOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S PARK LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-5753
Mailing Address - Country:US
Mailing Address - Phone:580-379-6550
Mailing Address - Fax:580-379-6559
Practice Address - Street 1:304 S PARK LN
Practice Address - Street 2:SUITE B
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5753
Practice Address - Country:US
Practice Address - Phone:580-379-6550
Practice Address - Fax:580-379-6559
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24330207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200053860AMedicaid
OK200053860BOtherSOONERCARE
I18519Medicare UPIN
OK248628901Medicare PIN
OKOK400316Medicare PIN
OK243516800Medicare ID - Type Unspecified