=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134195944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUILLERMO ABESADA-TERK JR MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2006
-----------------------------------------------------
Last Update Date | 10/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 SE OSCEOLA ST SUITE 201
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-223-5952
-----------------------------------------------------
Fax | 772-223-5956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 SE OSCEOLA ST SUITE 201
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-223-5952
-----------------------------------------------------
Fax | 772-223-5956
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRACTICE MD
-----------------------------------------------------
Name | DR. GUILLERMO ABESADA-TERK JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 772-223-5952
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | ME58862
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------