Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2012019219 | MO |
N | 2080P0204X | Pediatric Emergency Doctor | 2012019219 | MO |
NPI | 1114156221 |
---|---|
Provider Name | Dr. George Abraham |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2009 |
Last Update Date | 24/06/2015 |