Healthcare Provider Details

I. General information

NPI: 1386606325
Provider Name (Legal Business Name): GERALD M ABRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11983 TAMIAMI TRL N STE 120
NAPLES FL
34110-1601
US

IV. Provider business mailing address

PO BOX 881832
PORT SAINT LUCIE FL
34988-1832
US

V. Phone/Fax

Practice location:
  • Phone: 239-334-1478
  • Fax: 772-673-4623
Mailing address:
  • Phone: 772-678-1147
  • Fax: 772-673-4623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME38969
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME0038969
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0038969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: