Provider Demographics
NPI:1851473177
Name:ABRAMSON, KEEVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEEVAN
Middle Name:
Last Name:ABRAMSON
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 1:850 SEQUOIA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437
Mailing Address - Country:US
Mailing Address - Phone:707-964-0259
Mailing Address - Fax:707-964-0765
Practice Address - Street 1:850 SEQUOIA CIRCLE
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-964-0259
Practice Address - Fax:707-964-0765
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19197207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48956YMedicaid
CA553847Medicare ID - Type Unspecified
CAYYY48956YMedicaid