Provider Demographics
NPI:1134200066
Name:MIQUEL, GEORGE JR (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MIQUEL
Suffix:JR
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 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 505
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-399-8090
Mailing Address - Fax:904-399-8086
Practice Address - Street 1:3599 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 505
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4252
Practice Address - Country:US
Practice Address - Phone:904-399-8090
Practice Address - Fax:904-399-8086
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040784208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15726OtherBLUE CROSS BLUE SHIELD
FL592228181OtherHUMANA
FL592228181OtherAETNA
FL592228181OtherHUMANA
FL15726Medicare ID - Type Unspecified