Provider Demographics
NPI:1487849832
Name:GEORGE F DAVIGLUS MD PA
Entity Type:Organization
Organization Name:GEORGE F DAVIGLUS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:DAVIGLUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-693-6902
Mailing Address - Street 1:1190 NW 95TH ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2063
Mailing Address - Country:US
Mailing Address - Phone:305-778-4877
Mailing Address - Fax:305-859-2292
Practice Address - Street 1:1190 NW 95 STREET
Practice Address - Street 2:SUITE 404
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2067
Practice Address - Country:US
Practice Address - Phone:305-778-4877
Practice Address - Fax:395-859-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL01119261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center