Healthcare Provider Details

I. General information

NPI: 1730192972
Provider Name (Legal Business Name): MR. GEORGE COLE PHILHOWER III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 LYONS RD 304
COCONUT CREEK FL
33063-9603
US

IV. Provider business mailing address

1821 LYONS RD, 304
COCONUT CREEK FL
33063-9277
US

V. Phone/Fax

Practice location:
  • Phone: 954-675-9289
  • Fax:
Mailing address:
  • Phone: 954-675-9289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number229616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: