Provider Demographics
NPI:1710036587
Name:ABU, ABRAHAM G (PA-C)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:G
Last Name:ABU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:550 17TH AVE
Practice Address - Street 2:5TH FL
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5788
Practice Address - Country:US
Practice Address - Phone:206-386-3880
Practice Address - Fax:206-386-3882
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11053363A00000X
WAPA10004262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8504441Medicaid
WA0229007OtherLABOR & INDUSTRIES
OR50060526Medicaid
WA0229007OtherLABOR & INDUSTRIES
ORQ37734Medicare UPIN
WA0229007OtherLABOR & INDUSTRIES