Provider Demographics
NPI:1649482084
Name:ABRAMS, JOSHUA (DO)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 E MYRTLE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5514
Mailing Address - Country:US
Mailing Address - Phone:602-944-2900
Mailing Address - Fax:602-944-0064
Practice Address - Street 1:1635 E MYRTLE AVE STE 400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5514
Practice Address - Country:US
Practice Address - Phone:602-944-2900
Practice Address - Fax:602-944-0064
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005694207XS0117X, 207X00000X, 207XS0117X
CA20A11072207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ341246Medicaid
AZ5550830001OtherMEDICARE NSC SCW
AZ5550830003OtherMEDICARE NSC PEORIA
AZ5550830003OtherMEDICARE NSC PEORIA