Provider Demographics
NPI:1609857754
Name:ABRAHAM, AKRAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:AKRAM
Middle Name:R
Last Name:ABRAHAM
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 1:920 N 8TH ST/PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-2026
Mailing Address - Country:US
Mailing Address - Phone:580-688-2200
Mailing Address - Fax:580-688-2229
Practice Address - Street 1:920 N 8TH ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550-2026
Practice Address - Country:US
Practice Address - Phone:580-688-2200
Practice Address - Fax:580-688-2229
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100034510EMedicaid
OK1609857754Medicare PIN
OK100034510EMedicaid