Healthcare Provider Details

I. General information

NPI: 1609857754
Provider Name (Legal Business Name): AKRAM R. ABRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N 8TH ST
HOLLIS OK
73550-2026
US

IV. Provider business mailing address

920 N 8TH ST/PO BOX 431
HOLLIS OK
73550-2026
US

V. Phone/Fax

Practice location:
  • Phone: 580-688-2200
  • Fax: 580-688-2229
Mailing address:
  • Phone: 580-688-2200
  • Fax: 580-688-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21350
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: