Provider Demographics
NPI:1598799181
Name:MEDINA, ABDON J (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDON
Middle Name:J
Last Name:MEDINA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:4848 COCONUT CREEK PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3904
Practice Address - Country:US
Practice Address - Phone:954-379-4848
Practice Address - Fax:954-642-3636
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME47189174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02161OtherBCBS
FL209883OtherAVMED
FL474368OtherWELLCARE
FLP01584477OtherRR MEDICARE
FLP971366OtherOPTIMUM
FL5410745OtherAETNA
FL10063OtherDIMENSION
FLP1035607OtherFREEDOM
FL02161OtherBCBS
FLP1035607OtherFREEDOM