Provider Demographics
NPI:1184627226
Name:ABRAHAM, JACOB E (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:E
Last Name:ABRAHAM
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 1:1 MERCY LN
Mailing Address - Street 2:STE 304
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6440
Mailing Address - Country:US
Mailing Address - Phone:501-321-4772
Mailing Address - Fax:501-321-2945
Practice Address - Street 1:1 MERCY LN
Practice Address - Street 2:STE 304
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6440
Practice Address - Country:US
Practice Address - Phone:501-321-4772
Practice Address - Fax:501-321-2945
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0070207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0500560611OtherRAILROAD MEDICARE
AR125247001Medicaid
AR5J413OtherBLUE CROSS/BLUE SHIELD
AR2020052OtherUNITED HEALTHCARE
AR0500560611OtherRAILROAD MEDICARE
AR5J413Medicare ID - Type Unspecified