Individual
DR. CRAIG LEON ABBOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3500 S WESTERN AVE, OKLAHOMA CITY, OK 73109-2413
(405) 632-5565
(405) 632-3538
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
17800
OK
207ND0101X
MOHS-Micrographic Surgery Physician
17800
OK
207ND0900X
Dermatopathology Physician
Primary
17800
OK
207NS0135X
Procedural Dermatology Physician
17800
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100746010A
—
OK
01
—
541511960-003
BLUE CROSS BLUE SHIELD
OK
Enumeration date
05/15/2006
Last updated
06/30/2021
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