Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME65809 | FL |
Y | 207QA0401X | Family Doctor - Addiction Medicine | ME65809 | FL |
N | 207RA0401X | Internist - Addiction Medicine | ME65809 | FL |
NPI | 1285676122 |
---|---|
Provider Name | John H. Abernethy |
First Address | Gainesville, FL 32608-4006 |
Second Address | Gainesville, FL 32608-4006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 11/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
27178 | BCBS (01) | FL |
379971800 | (05) | FL |
379971900 | (05) | FL |
G28098 | (02) |