Provider Demographics
NPI:1073967733
Name:GEORGE, PHILLIP T (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:T
Last Name:GEORGE
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 1:2601 S BAYSHORE DR
Mailing Address - Street 2:SUITE 725
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5417
Mailing Address - Country:US
Mailing Address - Phone:305-423-3262
Mailing Address - Fax:305-856-3149
Practice Address - Street 1:2601 S BAYSHORE DR
Practice Address - Street 2:SUITE 725
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-5417
Practice Address - Country:US
Practice Address - Phone:305-423-3262
Practice Address - Fax:305-856-3149
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist