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NPI Code Detail

MEDICARE: DR. GEORGE MEDZERIAN PH.D.

MEDICARE:  DR. GEORGE  MEDZERIAN  PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPY0003086FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1215000OTHERPHCS
25371572OTHERAETNA
3089002OTHERVALUE OPTIONS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134284920
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE MEDZERIAN PH.D.
Provider Business Mailing Address
First Line : 850 NW FEDERAL HWY # 114
Second Line :
City : STUART
State : FL
Zip : 34994-1019
Country : US
Telephone Number : 772-283-0013
Fax Number : 772-403-5817
Provider Business Practice Location Address
First Line : 850 NW FEDERAL HWY # 114
Second Line :
City : STUART
State : FL
Zip : 34994-1019
Country : US
Telephone Number : 772-283-0013
Fax Number : 772-403-5817
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2006
Last Update Date : 12/04/2012

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Directions to “ DR. GEORGE MEDZERIAN PH.D.” Practice Location

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