Provider Demographics
NPI:1699788851
Name:ABBOTT, EMILE GLINES III (MD)
Entity type:Individual
Prefix:
First Name:EMILE
Middle Name:GLINES
Last Name:ABBOTT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W CANTU RD
Mailing Address - Street 2:STE 500
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78842
Mailing Address - Country:US
Mailing Address - Phone:830-774-5517
Mailing Address - Fax:830-774-7439
Practice Address - Street 1:501 W CANTU RD
Practice Address - Street 2:STE 500
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-3013
Practice Address - Country:US
Practice Address - Phone:830-774-5517
Practice Address - Fax:830-774-7439
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00F12GMedicare ID - Type Unspecified
D39247Medicare UPIN