Provider Demographics
NPI:1285799056
Name:EMDUR, ABBY C (MD)
Entity type:Individual
Prefix:DR
First Name:ABBY
Middle Name:C
Last Name:EMDUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 W MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3128
Mailing Address - Country:US
Mailing Address - Phone:303-684-7880
Mailing Address - Fax:720-494-3107
Practice Address - Street 1:1925 W MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3128
Practice Address - Country:US
Practice Address - Phone:303-684-7880
Practice Address - Fax:720-494-3107
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86400207Y00000X
CO46431207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72087838Medicaid
COCO301051Medicare PIN
CO72087838Medicaid