Provider Demographics
NPI:1922082031
Name:EVERETT, GEORGE DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DOUGLAS
Last Name:EVERETT
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 1:2501 NORTH ORANGE AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-303-7270
Mailing Address - Fax:407-303-2553
Practice Address - Street 1:2501 NORTH ORANGE AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-303-7270
Practice Address - Fax:407-303-2553
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041387900Medicaid
FL47712YMedicare ID - Type Unspecified
FL041387900Medicaid
FL47712Medicare PIN