Provider Demographics
NPI:1538247770
Name:ABOOD, JEFFERY M (CRNA)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:M
Last Name:ABOOD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 VINCENT RD
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2917
Mailing Address - Country:US
Mailing Address - Phone:330-971-7123
Mailing Address - Fax:330-971-7119
Practice Address - Street 1:1900 23RD ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1404
Practice Address - Country:US
Practice Address - Phone:330-971-7123
Practice Address - Fax:330-971-7119
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.00590367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0751306Medicaid
OHH413990Medicare PIN
OH0751306Medicaid
OH000000129031OtherANTHEM PROVIDER NUMBER