1134195944 NPI number — GUILLERMO ABESADA-TERK JR MD PA

Table of content: (NPI 1134195944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134195944 NPI number — GUILLERMO ABESADA-TERK JR MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUILLERMO ABESADA-TERK JR MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134195944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 SE OSCEOLA ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34994-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-223-5952
Provider Business Mailing Address Fax Number:
772-223-5956

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 SE OSCEOLA ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34994-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-223-5952
Provider Business Practice Location Address Fax Number:
772-223-5956
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABESADA-TERK
Authorized Official First Name:
GUILLERMO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRACTICE MD
Authorized Official Telephone Number:
772-223-5952

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  ME58862 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11877 . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 052407700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7649249001 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com