Provider Demographics
NPI:1437252624
Name:BOTELHO, GEORGE MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MANUEL
Last Name:BOTELHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5456 GRAND PARK PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1455
Mailing Address - Country:US
Mailing Address - Phone:954-491-6969
Mailing Address - Fax:888-426-8955
Practice Address - Street 1:9033 GLADES ROAD, SUITE D
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4609
Practice Address - Country:US
Practice Address - Phone:954-491-6969
Practice Address - Fax:888-426-8955
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64267207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL222259OtherAVMED
FL23404OtherBC BS OF FLA
FL279755100Medicaid
FLE55349Medicare UPIN
FL279755100Medicaid