Provider Demographics
NPI:1346323888
Name:TREVINO, ABRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAM
Middle Name:
Last Name:TREVINO
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:1448 COMMON ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3162
Practice Address - Country:US
Practice Address - Phone:830-643-1762
Practice Address - Fax:830-609-7702
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13859207R00000X
TXM4602207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213500603Medicaid
TXP01547718OtherRAIROAD MEDICARE
TX213500601Medicaid
TX213500601Medicaid
TXTXB102861Medicare PIN