Provider Demographics
NPI:1932286416
Name:MAGRUDER, GEORGE BROCK JR (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:BROCK
Last Name:MAGRUDER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:120 EAST PAR STREET
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-843-5665
Mailing Address - Fax:407-872-7939
Practice Address - Street 1:120 EAST PAR STREET
Practice Address - Street 2:SUITE 2000
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-843-5665
Practice Address - Fax:407-872-7939
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-01-10
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Provider Licenses
StateLicense IDTaxonomies
FLME56293207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
08603YMedicare UPIN