Provider Demographics
NPI:1821094673
Name:TERMOTTO, GEORGE RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RONALD
Last Name:TERMOTTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3829 HOLLYWOOD BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6790
Mailing Address - Country:US
Mailing Address - Phone:954-966-7337
Mailing Address - Fax:954-966-4233
Practice Address - Street 1:3829 HOLLYWOOD BLVD
Practice Address - Street 2:STE D
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6790
Practice Address - Country:US
Practice Address - Phone:954-966-7337
Practice Address - Fax:954-966-4233
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29978208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068693000Medicaid
FLD27749Medicare UPIN