Provider Demographics
NPI:1851968382
Name:ABRAHAM, FREDERICK JAMES (DO)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JAMES
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:FREDDY
Other - Middle Name:JAMES
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1149 NEWELL DR # L3-100
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0236
Mailing Address - Country:US
Mailing Address - Phone:352-273-5550
Mailing Address - Fax:352-273-5575
Practice Address - Street 1:1149 NEWELL DR # L3-100
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0236
Practice Address - Country:US
Practice Address - Phone:352-273-5550
Practice Address - Fax:352-273-5575
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7540390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program