Provider Demographics
NPI:1316231608
Name:GEORGE T BESONG MD OB/GYN LLC
Entity Type:Organization
Organization Name:GEORGE T BESONG MD OB/GYN LLC
Other - Org Name:WOMEN'S HEALTH RESOURCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:TATAW
Authorized Official - Last Name:BESONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-279-0060
Mailing Address - Street 1:2728 ENTERPRISE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8276
Mailing Address - Country:US
Mailing Address - Phone:386-774-0109
Mailing Address - Fax:386-774-1203
Practice Address - Street 1:2728 ENTERPRISE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8276
Practice Address - Country:US
Practice Address - Phone:386-774-0109
Practice Address - Fax:386-774-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123086207PE0004X, 207Q00000X
FL207V00000X
FLME92729207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFK850AMedicare PIN