Provider Demographics
NPI:1720278393
Name:PHYSICIAN CARE INC
Entity Type:Organization
Organization Name:PHYSICIAN CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RESTEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-964-6500
Mailing Address - Street 1:132 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-4043
Mailing Address - Country:US
Mailing Address - Phone:904-964-6500
Mailing Address - Fax:904-964-9170
Practice Address - Street 1:132 E MADISON ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-4043
Practice Address - Country:US
Practice Address - Phone:904-964-6500
Practice Address - Fax:904-964-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL108914Medicare PIN
FL39265Medicare PIN