Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 05080 | MS |
Y | 208600000X | Surgeon | 05080 | MS |
NPI | 1013931674 |
---|---|
Provider Name | Ralph E Abraham |
First Address | Hattiesburg, MS 39401-7246 |
Second Address | Hattiesburg, MS 39401-7246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 23/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00012609 | (05) | MS |
1558916 | AMERICAN ADMIN GROUP (01) | MS |
332920374 | RAILROAD MEDICARE (01) | |
C48170 | (02) |