Provider Demographics
NPI:1689683104
Name:KHOURI, GEORGE G (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:G
Last Name:KHOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:SUITE 8100
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-366-8300
Mailing Address - Fax:561-366-8320
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 8100
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-366-8300
Practice Address - Fax:561-366-8320
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FLME62262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23713Medicare ID - Type UnspecifiedPROVIDER