Healthcare Provider Details

I. General information

NPI: 1134313273
Provider Name (Legal Business Name): GUILLERMO ABESADA-TERK JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SE OCEAN BLVD STE 102
STUART FL
34994-2236
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-4061
  • Fax: 772-287-4176
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME58862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: