Provider Demographics
NPI:1154379881
Name:TRIM, GEORGE G (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:G
Last Name:TRIM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12014 S.W. LAGUNA BAY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-7755
Mailing Address - Country:US
Mailing Address - Phone:609-709-7185
Mailing Address - Fax:772-448-8829
Practice Address - Street 1:264 NW PEACOCK BLVD.
Practice Address - Street 2:SUITE #103
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2272
Practice Address - Country:US
Practice Address - Phone:772-204-2562
Practice Address - Fax:609-489-4651
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51879208D00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE23759Medicare UPIN