Provider Demographics
NPI:1184624660
Name:AYCOCK, GEORGE R JR (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:AYCOCK
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 1:1717 N E ST
Mailing Address - Street 2:SUITE 331
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6339
Mailing Address - Country:US
Mailing Address - Phone:850-484-6500
Mailing Address - Fax:850-857-1747
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 331
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-484-6500
Practice Address - Fax:850-857-1747
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12442207RC0000X
FLME44213207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0690937 00Medicaid
AL110445Medicaid
AL110310Medicaid
AL009965180Medicaid
AL110241Medicaid
AL110312Medicaid
FLAA2781525OtherDEA
AL110455Medicaid
AL110241Medicaid
AL110310Medicaid
AL110310Medicaid
AL110362Medicaid
AL110312Medicaid