Provider Demographics
NPI:1033422480
Name:MEDARIS, ABRAHAM BLAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:BLAIN
Last Name:MEDARIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:STE 364B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-525-4429
Mailing Address - Fax:314-525-7260
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:STE 364B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-525-4429
Practice Address - Fax:314-525-7260
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2017-03-14
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Provider Licenses
StateLicense IDTaxonomies
NE63692084P0800X
MO20140089972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry