Provider Demographics
NPI:1023197175
Name:ABBOTT, ABRAHAM GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:GEORGE
Last Name:ABBOTT
Suffix:
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 1:6750 WEST LOOP S STE 950
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4124
Mailing Address - Country:US
Mailing Address - Phone:213-838-0800
Mailing Address - Fax:
Practice Address - Street 1:6750 WEST LOOP S STE 950
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4124
Practice Address - Country:US
Practice Address - Phone:213-838-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22772207P00000X
TXP9781207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A227720Medicaid
00A227721Medicare ID - Type Unspecified
CA00A227720Medicaid