Provider Demographics
NPI:1629017967
Name:HOCHREITER, GEORGE C (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:C
Last Name:HOCHREITER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SOUTHPARK BLVD
Mailing Address - Street 2:#102
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5190
Mailing Address - Country:US
Mailing Address - Phone:904-823-3764
Mailing Address - Fax:904-823-8967
Practice Address - Street 1:150 SOUTHPARK BLVD
Practice Address - Street 2:#102
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5190
Practice Address - Country:US
Practice Address - Phone:904-823-3764
Practice Address - Fax:904-823-8967
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004077L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA211083OtherJOHNS HOPKINS
PA911567OtherHIGHMARK BLUE SHIELD
MD883201OtherCAREFIRST MD BCBS
PA000898510Medicaid
PA4558489OtherAETNA
PA911567OtherHIGHMARK BLUE SHIELD
PA044572FLTMedicare PIN
B34276Medicare UPIN