Provider Demographics
NPI:1598870883
Name:DE JESUS, ANIBAL (MD)
Entity type:Individual
Prefix:DR
First Name:ANIBAL
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15837 PENDIO DR
Mailing Address - Street 2:
Mailing Address - City:BELLA COLLINA
Mailing Address - State:FL
Mailing Address - Zip Code:34756-3649
Mailing Address - Country:US
Mailing Address - Phone:832-405-0546
Mailing Address - Fax:
Practice Address - Street 1:1900 DON WICKHAM DR STE 300
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1979
Practice Address - Country:US
Practice Address - Phone:352-394-4091
Practice Address - Fax:713-458-4229
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1177207L00000X
FLME139497207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EQ084OtherBCBS
TXP01441236OtherRR MEDICARE
TX8EQ096OtherBLUE CROSS BLUE SHIELD
TX117009404Medicaid
TX377852YK6UMedicare PIN
TX8EQ096OtherBLUE CROSS BLUE SHIELD