Provider Demographics
NPI:1932131752
Name:GEORGES, CLETUS ROY (MD)
Entity Type:Individual
Prefix:
First Name:CLETUS
Middle Name:ROY
Last Name:GEORGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CLETUS
Other - Middle Name:
Other - Last Name:GEORGES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1420 CELEBRATION BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5161
Mailing Address - Country:US
Mailing Address - Phone:407-566-9899
Mailing Address - Fax:407-566-9893
Practice Address - Street 1:40107 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-5901
Practice Address - Country:US
Practice Address - Phone:407-599-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73722208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ00261096OtherRAILROAD MEDICARE
FL112370600Medicaid
340019060OtherRAILROAD MEDICARE
FLE0082ZMedicare PIN