Provider Demographics
NPI:1801821715
Name:BESONG, GEORGE T (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:T
Last Name:BESONG
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 1:2111 HONTOON RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-4308
Mailing Address - Country:US
Mailing Address - Phone:386-747-9771
Mailing Address - Fax:
Practice Address - Street 1:2275 N VOLUSIA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-2833
Practice Address - Country:US
Practice Address - Phone:386-774-0109
Practice Address - Fax:386-774-1203
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92729207V00000X
FLME92792208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16012OtherBCBS
FL274459700Medicaid
FL16012OtherBCBS
FL16012XMedicare PIN
FL274459700Medicaid
FL16012ZMedicare PIN