Provider Demographics
NPI:1134284920
Name:MEDZERIAN, GEORGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:MEDZERIAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 NW FEDERAL HWY # 114
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-1019
Mailing Address - Country:US
Mailing Address - Phone:772-283-0013
Mailing Address - Fax:772-403-5817
Practice Address - Street 1:850 NW FEDERAL HWY # 114
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-1019
Practice Address - Country:US
Practice Address - Phone:772-283-0013
Practice Address - Fax:772-403-5817
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003086103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
215000OtherPHCS
5371572OtherAETNA
089002OtherVALUE OPTIONS
5371572OtherAETNA