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Individual

DR. ABDON J. MEDINA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4848 COCONUT CREEK PKWY, SUITE 100, COCONUT CREEK, FL 33063-3904
(954) 379-4848
(954) 642-3636
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS DEPT., FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
ME47189
FL
2085R0001X
Radiation Oncology Physician
Primary
ME47189
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
02161
BCBS
FL
01
10063
DIMENSION
FL
01
209883
AVMED
FL
01
474368
WELLCARE
FL
01
5410745
AETNA
FL
01
P01584477
RR MEDICARE
FL
01
P1035607
FREEDOM
FL
01
P971366
OPTIMUM
FL
Enumeration date
07/10/2006
Last updated
10/20/2016
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