Provider Demographics
NPI:1437158938
Name:ABOUD, DWAYNE MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:MITCHELL
Last Name:ABOUD
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 1:4687 N MESA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6185
Mailing Address - Country:US
Mailing Address - Phone:915-500-4086
Mailing Address - Fax:915-995-4996
Practice Address - Street 1:11860 VISTA DEL SOL DR STE 150
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6128
Practice Address - Country:US
Practice Address - Phone:915-808-4000
Practice Address - Fax:915-995-4996
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP085Y0902Medicaid
TXB20760Medicare UPIN
TX85Y090Medicare PIN