Provider Demographics
NPI:1376540104
Name:ABRAHAM, LARRY L (DPM)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:L
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2021
Mailing Address - Country:US
Mailing Address - Phone:316-321-2050
Mailing Address - Fax:316-321-3309
Practice Address - Street 1:321 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2021
Practice Address - Country:US
Practice Address - Phone:316-321-2050
Practice Address - Fax:316-321-3309
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00110213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST43831Medicare UPIN