MEDICARE: DR. JACOB E ABRAHAM M.D.

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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	E0070	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0500560611	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5J413	OTHER	AR	BLUE CROSS/BLUE SHIELD
4	2020052	OTHER	AR	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1184627226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB E ABRAHAM M.D.

Provider Business Mailing Address
First Line	:	1 MERCY LN
Second Line	:	STE 304
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6440
Country	:	US
Telephone Number	:	501-321-4772
Fax Number	:	501-321-2945

Provider Business Practice Location Address
First Line	:	1 MERCY LN
Second Line	:	STE 304
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6440
Country	:	US
Telephone Number	:	501-321-4772
Fax Number	:	501-321-2945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/06/2008

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Directions to “ DR. JACOB E ABRAHAM M.D.” Practice Location

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