Provider Demographics
NPI:1336474535
Name:ABRAHAM, ANTHONY M (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:413 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7329
Mailing Address - Country:US
Mailing Address - Phone:870-793-4445
Mailing Address - Fax:870-698-8844
Practice Address - Street 1:620 W GROVE ST STE 201
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4425
Practice Address - Country:US
Practice Address - Phone:870-875-5580
Practice Address - Fax:870-875-5584
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12386208600000X
OH34.010551208600000X
ARE-9419208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery