Individual
DR. MARK FREDRIC ABBOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1619 N GREENWOOD ST STE 103, PUEBLO, CO 81003-2655
(719) 542-2167
Mailing address
1619 N GREENWOOD ST STE 103, PUEBLO, CO 81003-2655
(719) 542-2167
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
149032
NC
2085R0202X
Diagnostic Radiology Physician
8495680-1205
UT
2085R0204X
Vascular & Interventional Radiology Physician
8495680-1205
UT
2085R0204X
Vascular & Interventional Radiology Physician
Primary
DR.0056380
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10000009999001
BCBSU
UT
01
—
107120161102
SELECTHEALTH
UT
01
—
1137616
DMBA
UT
01
—
1295993871
EMI HEALTH
UT
05
—
1295993871
—
UT
01
—
145448
PEHP
UT
01
—
4697935
AETNA HEALTHCARE
UT
01
—
P01180702
RAILROAD MEDICARE
UT
Enumeration date
05/29/2008
Last updated
04/22/2025
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