Healthcare Provider Details

I. General information

NPI: 1518377662
Provider Name (Legal Business Name): STACEY ABRAHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 09/20/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 DALLAS PKWY STE 200
FRISCO TX
75033-4135
US

IV. Provider business mailing address

9990 DALLAS PKWY STE 200
FRISCO TX
75033-4135
US

V. Phone/Fax

Practice location:
  • Phone: 469-872-9966
  • Fax: 833-226-7406
Mailing address:
  • Phone: 214-387-8288
  • Fax: 833-226-7406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10050316
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: