Provider Demographics
NPI:1184707887
Name:JOHN, ABRAHAM S (MD)
Entity type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:S
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5030 CRENSHAW RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3140
Mailing Address - Country:US
Mailing Address - Phone:832-448-6081
Mailing Address - Fax:832-448-6091
Practice Address - Street 1:5030 CRENSHAW RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3140
Practice Address - Country:US
Practice Address - Phone:832-448-6081
Practice Address - Fax:832-448-6091
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL7430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181889001Medicaid
I06712Medicare UPIN
TX181889001Medicaid