Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME58862 | FL |
N | 111NI0900X | Internist | ME58862 | FL |
Y | 207RX0202X | Medical Oncology | ME58862 | FL |
NPI | 1134313273 |
---|---|
Provider Name | Guillermo Abesada-Terk JR. |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Stuart, FL 34994-2236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2007 |
Last Update Date | 11/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019909700 | (05) | FL |
11877 | BCBS (01) | FL |
E77903 | (02) | FL |