Provider Demographics
NPI:1346348281
Name:GEORGE G FEUSSNER MD PA
Entity Type:Organization
Organization Name:GEORGE G FEUSSNER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FEUSSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-6430
Mailing Address - Street 1:7106 NW 11TH PLACE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3157
Mailing Address - Country:US
Mailing Address - Phone:352-331-6430
Mailing Address - Fax:352-331-3515
Practice Address - Street 1:7106 NW 11TH PLACE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3157
Practice Address - Country:US
Practice Address - Phone:352-331-6430
Practice Address - Fax:352-331-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00198362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057519400Medicaid
FL5944850001Medicare NSC
FL057519400Medicaid
E11992Medicare UPIN