Provider Demographics
NPI:1316329873
Name:CO, EDGIE ABUAN (DO)
Entity type:Individual
Prefix:DR
First Name:EDGIE
Middle Name:ABUAN
Last Name:CO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PCMH BDAACH/DHA
Mailing Address - Street 2:BLDG 3031, ROOM CG129
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96271
Mailing Address - Country:US
Mailing Address - Phone:315-737-5659
Mailing Address - Fax:
Practice Address - Street 1:PCMH BDAACH/DHA
Practice Address - Street 2:BLDG 3031, ROOM CG129
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96271
Practice Address - Country:US
Practice Address - Phone:315-737-5659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A15017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program