Provider Demographics
NPI:1508357625
Name:BAHADUE, GEORGE P (MD, DO,)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:BAHADUE
Suffix:
Gender:M
Credentials:MD, DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19665 E SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2325
Mailing Address - Country:US
Mailing Address - Phone:954-495-7560
Mailing Address - Fax:305-495-7560
Practice Address - Street 1:19665 E SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2325
Practice Address - Country:US
Practice Address - Phone:954-495-7560
Practice Address - Fax:305-495-7560
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02879821021OtherAMA ME
FLB300-315-54-229-0OtherFLORIDA DRIVER LIC