Provider Demographics
NPI:1760493902
Name:HORATIO V. CABASARES, MD, PC
Entity Type:Organization
Organization Name:HORATIO V. CABASARES, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HORATIO
Authorized Official - Middle Name:V
Authorized Official - Last Name:CABASARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-987-0035
Mailing Address - Street 1:1020 KEITH DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2947
Mailing Address - Country:US
Mailing Address - Phone:478-987-0035
Mailing Address - Fax:478-987-6918
Practice Address - Street 1:1020 KEITH DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2947
Practice Address - Country:US
Practice Address - Phone:478-987-0035
Practice Address - Fax:478-987-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018280208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000199493AMedicaid
GA000199493AMedicaid
GA379703074AMedicare PIN