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NPI Code Detail

MEDICARE: DR. ABRAHAM JOHN MD

MEDICARE: DR. ABRAHAM JOHN 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
1207R00000XInternal Medicine PhysicianP1657TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1464086YLPSOTHERWMG MEDICARE

General Provider Information

NPI Number : 1043309438
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ABRAHAM JOHN MD
Provider Business Mailing Address
First Line : 12758 CIMARRON PATH
Second Line : STE 128
City : SAN ANTONIO
State : TX
Zip : 78249-3426
Country : US
Telephone Number : 210-479-3444
Fax Number : 888-419-7516
Provider Business Practice Location Address
First Line : 2222 ROSEWOOD AVE
Second Line :
City : AUSTIN
State : TX
Zip : 78702-2206
Country : US
Telephone Number : 512-465-4840
Fax Number : 512-465-4841
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 12/30/2015

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