Provider Demographics
NPI:1780606541
Name:ABRAHAM, BOBBY (MD)
Entity type:Individual
Prefix:DR
First Name:BOBBY
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 1:1027 SOUTH FLORIDA AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955
Mailing Address - Country:US
Mailing Address - Phone:321-504-3999
Mailing Address - Fax:321-504-3818
Practice Address - Street 1:1027 SOUTH FLORIDA AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955
Practice Address - Country:US
Practice Address - Phone:321-504-3999
Practice Address - Fax:321-504-3818
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23940OtherBLUE CROSS BLUE SHIELD
FL374637200Medicaid
FL0622733OtherAETNA
FL23940OtherBLUE CROSS BLUE SHIELD
FLK3326Medicare ID - Type Unspecified