Individual
ROY ABRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W VOTAW ST, PORTLAND, IN 47371-1322
(260) 726-7131
Mailing address
1300 S JACKSON ST, FRANKFORT, IN 46041-3313
(765) 656-3150
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01072420A
IN
207Q00000X
Family Medicine Physician
01072420A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001327193
ANTHEM PTAN
IN
01
—
000001327195
ANTHEM PTAN
IN
01
—
000001643117
ANTHEM PTAN
IN
01
—
01072420A
LICENCE
IN
05
—
201178290
—
IN
Enumeration date
09/02/2010
Last updated
05/05/2025
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