=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699760678
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUAN C ABANSES MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2005
-----------------------------------------------------
Last Update Date | 07/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 W DR MARTIN LUTHER KING JR BLVD EM DEPT
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33607-6307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-870-4000
-----------------------------------------------------
Fax | 386-274-7801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9790
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32120-9790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-274-7800
-----------------------------------------------------
Fax | 386-274-7801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PP0204X
-----------------------------------------------------
Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
-----------------------------------------------------
License Number | ME114914
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------