Provider Demographics
NPI:1386606325
Name:ABRAHAM, GERALD M (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:M
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 881832
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34988-1832
Mailing Address - Country:US
Mailing Address - Phone:772-678-1147
Mailing Address - Fax:772-673-4623
Practice Address - Street 1:11983 TAMIAMI TRL N STE 120
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1601
Practice Address - Country:US
Practice Address - Phone:239-334-1478
Practice Address - Fax:772-673-4623
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38969208VP0000X
FLME0038969208VP0014X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
092955000OtherMAGELLAN
FL09749OtherBC BS
206235OtherHARMONY
0000000OtherCIGNA
FL062913800Medicaid
09749OtherAETNA
260010362OtherRAILROAD MEDICARE
FL09749OtherBLUE CROSS BLUE SHIELD
027338OtherBEACON ( VALUE OPTIONS)