Provider Demographics
NPI:1306802558
Name:ABRAHAMS, JEFFREY P
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:ABRAHAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 FOREST BEACH DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5850
Mailing Address - Country:US
Mailing Address - Phone:310-993-3457
Mailing Address - Fax:
Practice Address - Street 1:3620 FOREST BEACH DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5850
Practice Address - Country:US
Practice Address - Phone:310-993-3457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60603297207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60603297Medicaid
CA00A409200Medicaid
F15058Medicare UPIN
CAFT325ZMedicare PIN