Provider Demographics
NPI:1912102815
Name:ABRAHAM, EUGENE R (LAC)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:R
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 KEAWE ST STE 303
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2486
Mailing Address - Country:US
Mailing Address - Phone:808-933-1300
Mailing Address - Fax:808-427-0058
Practice Address - Street 1:64 KEAWE ST STE 303
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2486
Practice Address - Country:US
Practice Address - Phone:808-933-1300
Practice Address - Fax:808-427-0058
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI517171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist