Provider Demographics
NPI:1699760678
Name:ABANSES, JUAN C (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:ABANSES
Suffix:
Gender:M
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:PO BOX 9790
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9790
Mailing Address - Country:US
Mailing Address - Phone:386-274-7800
Mailing Address - Fax:386-274-7801
Practice Address - Street 1:3001 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:EM DEPT
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6307
Practice Address - Country:US
Practice Address - Phone:813-870-4000
Practice Address - Fax:386-274-7801
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114914207PP0204X, 207PP0204X
AL00025840207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117409500Medicaid
FLGX151ZOtherMEDICARE PTAN
FL14P1ROtherBCBS
AL051522698Medicaid
AL200174262OtherTRICARE
AL200174262OtherCHAMPUS
AL051522698OtherBCBS OF ALABAMA
AL75-60010OtherUNITED HEALTH CARE
AL7588591OtherAETNA
FLGX151ZOtherMEDICARE PTAN
AL051554754Medicaid
FLGX151ZOtherMEDICARE PTAN
AL051522698Medicaid
AL102I934594Medicare PIN