Organization
ANES W. ABRAHAM M.D. P.A.
Active
Other names
Pediatric and Teen Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
ANES WILEY ABRAHAM M.D. (PRESIDENT)
(870) 763-1700
Entity
Organization
Contact information
Practice address
1521 N 10TH ST, SUITE H, BLYTHEVILLE, AR 72315-1405
(870) 763-1700
(870) 763-2903
Mailing address
1521 N 10TH ST, SUITE H, BLYTHEVILLE, AR 72315-1405
(870) 763-1700
(870) 763-2903
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R3291
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57920
CLINIC BCBS
AR
Enumeration date
11/02/2006
Last updated
08/22/2020
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