Provider Demographics
NPI:1043309438
Name:JOHN, ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12758 CIMARRON PATH
Mailing Address - Street 2:STE 128
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3426
Mailing Address - Country:US
Mailing Address - Phone:210-479-3444
Mailing Address - Fax:888-419-7516
Practice Address - Street 1:2222 ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2206
Practice Address - Country:US
Practice Address - Phone:512-465-4840
Practice Address - Fax:512-465-4841
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1657207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
464086YLPSOtherWMG MEDICARE