Provider Demographics
NPI:1659575512
Name:GEORGE, JEFFREY C (IDC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:GEORGE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 814 BOX 19
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:09865
Mailing Address - Country:GR
Mailing Address - Phone:01130282-102-1590
Mailing Address - Fax:
Practice Address - Street 1:PSC 814 BOX 19
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:09865
Practice Address - Country:GR
Practice Address - Phone:01130282-102-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman