Provider Demographics
NPI:1477802858
Name:ABRAHAM, MALOUF JR (MD)
Entity Type:Individual
Prefix:
First Name:MALOUF
Middle Name:
Last Name:ABRAHAM
Suffix:JR
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:P.O. BOX 1283
Mailing Address - Street 2:604 MAIN STREET
Mailing Address - City:CANADIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79014
Mailing Address - Country:US
Mailing Address - Phone:806-323-6554
Mailing Address - Fax:806-323-9001
Practice Address - Street 1:604 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:TX
Practice Address - Zip Code:79014
Practice Address - Country:US
Practice Address - Phone:806-323-6554
Practice Address - Fax:806-323-9001
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine