Provider Demographics
NPI:1174752927
Name:PORT, ABBIE M (PA-C)
Entity type:Individual
Prefix:
First Name:ABBIE
Middle Name:M
Last Name:PORT
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:855 A AVE NE STE 105
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5060
Mailing Address - Country:US
Mailing Address - Phone:319-368-5992
Mailing Address - Fax:319-369-8251
Practice Address - Street 1:855 A AVE NE STE 105
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5060
Practice Address - Country:US
Practice Address - Phone:319-368-5992
Practice Address - Fax:319-369-8251
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2024-03-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1174752927Medicaid
IAP00831041 CC6519OtherRR MEDICARE
IA71926082Medicare PIN