Provider Demographics
NPI:1699185371
Name:RAVID AVRAHAM PLLC
Entity Type:Organization
Organization Name:RAVID AVRAHAM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AVRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-213-6543
Mailing Address - Street 1:2828 LEMMON AVE
Mailing Address - Street 2:APT 4154
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3706
Mailing Address - Country:US
Mailing Address - Phone:940-284-3884
Mailing Address - Fax:877-442-9313
Practice Address - Street 1:2828 LEMMON AVE
Practice Address - Street 2:APT 4154
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3706
Practice Address - Country:US
Practice Address - Phone:940-284-3884
Practice Address - Fax:877-442-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5928208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty