Provider Demographics
NPI:1295844132
Name:GLORIA B ABRAHAM-COX
Entity Type:Organization
Organization Name:GLORIA B ABRAHAM-COX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ABRAHAM-COX
Authorized Official - Suffix:
Authorized Official - Credentials:MDPA
Authorized Official - Phone:210-222-8798
Mailing Address - Street 1:311 CAMDEN ST STE 412
Mailing Address - Street 2:MADISON SQUARE MEDICAL BLDG
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215
Mailing Address - Country:US
Mailing Address - Phone:210-222-8798
Mailing Address - Fax:210-222-9654
Practice Address - Street 1:311 CAMDEN ST STE 412
Practice Address - Street 2:MADISON SQUARE MEDICAL BLDG
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215
Practice Address - Country:US
Practice Address - Phone:210-222-8798
Practice Address - Fax:210-222-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7969208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121520403Medicaid
TX121520402Medicaid