Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN19695 | FL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN19695 | FL |
NPI | 1104188937 |
---|---|
Provider Name | Dr. Michael Alexander Abraham |
First Address | Gainesville, FL 32610-0416 |
Second Address | Gainesville, FL 32610-0416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2012 |
Last Update Date | 25/05/2016 |