Provider Demographics
NPI:1457313421
Name:HERDEL, GEORGE FREDRICK III (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:FREDRICK
Last Name:HERDEL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:FREDRICK
Other - Last Name:HERDEL
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:845 STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7271
Mailing Address - Country:US
Mailing Address - Phone:386-423-2550
Mailing Address - Fax:386-423-2525
Practice Address - Street 1:845 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7271
Practice Address - Country:US
Practice Address - Phone:386-423-2550
Practice Address - Fax:386-423-2525
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4592Medicare ID - Type Unspecified
FLH23981Medicare UPIN