Provider Demographics
NPI:1457178071
Name:DORTA CHAPIN, GEORGE MARCEL (PA)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MARCEL
Last Name:DORTA CHAPIN
Suffix:
Gender:
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10618 DEERBERRY DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-6890
Mailing Address - Country:US
Mailing Address - Phone:813-453-5023
Mailing Address - Fax:
Practice Address - Street 1:1539 DALE MABRY HWY STE 102
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-3008
Practice Address - Country:US
Practice Address - Phone:813-909-7102
Practice Address - Fax:813-909-0199
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR2307-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant