Healthcare Provider Details

I. General information

NPI: 1699760678
Provider Name (Legal Business Name): JUAN C ABANSES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W DR MARTIN LUTHER KING JR BLVD EM DEPT
TAMPA FL
33607-6307
US

IV. Provider business mailing address

PO BOX 9790
DAYTONA BEACH FL
32120-9790
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-4000
  • Fax: 386-274-7801
Mailing address:
  • Phone: 386-274-7800
  • Fax: 386-274-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberME114914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: