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General NPI Number Information
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NPI Number | 1053490144
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Entity Type | Organization
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Legal Business Name | ANES W. ABRAHAM M.D. P.A.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1521 N 10TH ST SUITE H
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-1405
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Country | US
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Telephone | 870-763-1700
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Fax | 870-763-2903
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Provider Business Mailing Address
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Address Line | 1521 N 10TH ST SUITE H
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-1405
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Country | US
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Telephone | 870-763-1700
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Fax | 870-763-2903
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANES WILEY ABRAHAM
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Credential | M.D.
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Telephone | 870-763-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R3291
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License Number State | AR
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