Provider Demographics
NPI:1457353948
Name:EDOUARD, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:EDOUARD
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 1:4330 W BROWARD BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3775
Mailing Address - Country:US
Mailing Address - Phone:954-587-0351
Mailing Address - Fax:954-990-6464
Practice Address - Street 1:4330 W BROWARD BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3775
Practice Address - Country:US
Practice Address - Phone:954-587-0351
Practice Address - Fax:954-990-6464
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54597207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045656099Medicaid
FL08301ZMedicare PIN
A65109Medicare UPIN