Basic Information
| Provider Information | |||||||||
| NPI: | 1699760678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABANSES | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9790 | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321209790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862747800 | ||||||||
| FaxNumber: | 3862747801 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 W DR MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | EM DEPT | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138704000 | ||||||||
| FaxNumber: | 3862747801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 05/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP3000X | 00025840 | AL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 207P00000X | 00025840 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PP0204X | ME114914 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 007958000 | 05 | FL | MEDICAID | 051522729 | 01 | AL | BCBS | OTHER | 14P1R | 01 | FL | BCBS | OTHER | 051522698 | 05 | AL | MEDICAID | 200174262 | 01 | AL | TRICARE | OTHER | 200174262 | 01 | AL | CHAMPUS | OTHER | 051522698 | 01 | AL | BCBS OF ALABAMA | OTHER | 75-60010 | 01 | AL | UNITED HEALTH CARE | OTHER | 7588591 | 01 | AL | AETNA | OTHER | GX151Z | 01 | FL | MEDICARE PTAN | OTHER | 051554754 | 05 | AL | MEDICAID |