Individual
DR. MABRA GLENN ABERNATHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
920 E 2ND AVE STE 201, CORALVILLE, IA 52241-2225
(319) 384-7000
(319) 467-2814
Mailing address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 384-7000
(319) 467-2814
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37536
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103989
—
SC
01
—
1184673972
WELLMARK
IA
01
—
1316922545
MEDICAID.... UIQC.... OCTC.....NL.....SEIC
IA
05
—
1316922545
—
IA
Enumeration date
12/09/2005
Last updated
04/17/2018
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