Provider Demographics
NPI:1205074135
Name:ABRAHAM, JENSON (MD)
Entity type:Individual
Prefix:MR
First Name:JENSON
Middle Name:
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 1:5016 S US HIGHWAY 75
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4584
Mailing Address - Country:US
Mailing Address - Phone:973-207-4589
Mailing Address - Fax:
Practice Address - Street 1:5016 S US HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4584
Practice Address - Country:US
Practice Address - Phone:903-416-4378
Practice Address - Fax:903-416-4980
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA037276OtherMLHC MEDICARE AA #
PA824305OtherMLHC B/S AA #
PA037276OtherMLHC MEDICARE AA #