Provider Demographics
NPI:1265496723
Name:GEORGE, SABU (MD)
Entity type:Individual
Prefix:DR
First Name:SABU
Middle Name:
Last Name:GEORGE
Suffix:
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 1:110 TRANQUILLA DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1744
Mailing Address - Country:US
Mailing Address - Phone:561-629-2361
Mailing Address - Fax:
Practice Address - Street 1:3355 BURNS RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4353
Practice Address - Country:US
Practice Address - Phone:561-630-5460
Practice Address - Fax:561-630-2892
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94095174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5988ZMedicare ID - Type Unspecified