Provider Demographics
NPI:1265411755
Name:ABUAN, JAIME D (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:D
Last Name:ABUAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1324 LAKELAND HILLS BLVD.
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2815 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2224
Practice Address - Country:US
Practice Address - Phone:863-284-5000
Practice Address - Fax:863-284-6904
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME90989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270542700Medicaid
FL270542700Medicaid
FL48480Medicare ID - Type Unspecified