MEDICARE: DR. PABLO ALABANZA MERCED M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	KY24420	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1439702	OTHER	KY	MEDICARE PTAN NUMBER

General Provider Information

NPI Number	:	1770633182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PABLO ALABANZA MERCED M.D.

Provider Business Mailing Address
First Line	:	PO BOX 606
Second Line	:
City	:	JACKSON
State	:	KY
Zip	:	41339-0606
Country	:	US
Telephone Number	:	606-666-4011
Fax Number	:	606-666-5801

Provider Business Practice Location Address
First Line	:	1389 HIGHWAY 15 N
Second Line	:
City	:	JACKSON
State	:	KY
Zip	:	41339-9404
Country	:	US
Telephone Number	:	606-666-4011
Fax Number	:	606-666-5801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	01/26/2011

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