Provider Demographics
NPI:1972078699
Name:GERIATRIC PHYSICIANS, INC
Entity Type:Organization
Organization Name:GERIATRIC PHYSICIANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-433-0776
Mailing Address - Street 1:1490 POLARIS ST
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3127
Mailing Address - Country:US
Mailing Address - Phone:321-433-0776
Mailing Address - Fax:954-944-0308
Practice Address - Street 1:1490 POLARIS ST
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3127
Practice Address - Country:US
Practice Address - Phone:213-433-0776
Practice Address - Fax:954-944-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty