MEDICARE: DR. BOBBY ABRAHAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME65338	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23940	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0622733	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1780606541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBBY ABRAHAM MD

Provider Business Mailing Address
First Line	:	1027 SOUTH FLORIDA AVENUE
Second Line	:	SUITE A
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955
Country	:	US
Telephone Number	:	321-504-3999
Fax Number	:	321-504-3818

Provider Business Practice Location Address
First Line	:	1027 SOUTH FLORIDA AVENUE
Second Line	:	SUITE A
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955
Country	:	US
Telephone Number	:	321-504-3999
Fax Number	:	321-504-3818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	06/24/2008

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