Provider Demographics
NPI:1629076674
Name:ABDO, RAYMOND (DPM)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:ABDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 KENNERLY RD STE 259B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2177
Mailing Address - Country:US
Mailing Address - Phone:314-596-9670
Mailing Address - Fax:314-722-3090
Practice Address - Street 1:10004 KENNERLY RD STE 259B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2177
Practice Address - Country:US
Practice Address - Phone:314-596-9670
Practice Address - Fax:314-722-3090
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016130213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV06012Medicare UPIN