Provider Demographics
NPI:1104012251
Name:GEORGE VAROUNIS DPM
Entity Type:Organization
Organization Name:GEORGE VAROUNIS DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAROUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-761-1411
Mailing Address - Street 1:1301 BEVILLE RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-9009
Mailing Address - Country:US
Mailing Address - Phone:386-761-1411
Mailing Address - Fax:386-761-8539
Practice Address - Street 1:1301 BEVILLE RD
Practice Address - Street 2:SUITE 17
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-9009
Practice Address - Country:US
Practice Address - Phone:386-761-1411
Practice Address - Fax:386-761-8539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-22
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2962213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4239Medicare PIN
FL0880600002Medicare NSC