Provider Demographics
NPI:1619145182
Name:BOBBY ABRAHAM MD PA
Entity Type:Organization
Organization Name:BOBBY ABRAHAM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-504-3999
Mailing Address - Street 1:1027 FLORIDA AVE S
Mailing Address - Street 2:#A
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2159
Mailing Address - Country:US
Mailing Address - Phone:321-504-3999
Mailing Address - Fax:321-504-3818
Practice Address - Street 1:1027 FLORIDA AVE S
Practice Address - Street 2:#A
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2159
Practice Address - Country:US
Practice Address - Phone:321-504-3999
Practice Address - Fax:321-504-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3326Medicare PIN