Provider Demographics
NPI:1134195944
Name:GUILLERMO ABESADA-TERK JR MD PA
Entity type:Organization
Organization Name:GUILLERMO ABESADA-TERK JR MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRACTICE MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:ABESADA-TERK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:772-223-5952
Mailing Address - Street 1:501 SE OSCEOLA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2301
Mailing Address - Country:US
Mailing Address - Phone:772-223-5952
Mailing Address - Fax:772-223-5956
Practice Address - Street 1:501 SE OSCEOLA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2301
Practice Address - Country:US
Practice Address - Phone:772-223-5952
Practice Address - Fax:772-223-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58862207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11877OtherBCBS OF FL
FL052407700Medicaid
FL7649249001OtherCIGNA
FL052407700Medicaid
FL7649249001OtherCIGNA