Provider Demographics
NPI:1225053192
Name:GE, QING (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:QING
Middle Name:
Last Name:GE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 SOUTH CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-2357
Mailing Address - Country:US
Mailing Address - Phone:386-788-6198
Mailing Address - Fax:386-788-4616
Practice Address - Street 1:3641 SOUTH CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-2357
Practice Address - Country:US
Practice Address - Phone:386-788-6198
Practice Address - Fax:386-788-4616
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME96155207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277580800Medicaid
FL277580800Medicaid