Healthcare Provider Details

I. General information

NPI: 1922082031
Provider Name (Legal Business Name): GEORGE DOUGLAS EVERETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 NORTH ORANGE AVE SUITE 235
ORLANDO FL
32804
US

IV. Provider business mailing address

2501 NORTH ORANGE AVE SUITE 235
ORLANDO FL
32804
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7270
  • Fax: 407-303-2553
Mailing address:
  • Phone: 407-303-7270
  • Fax: 407-303-2553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME46420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: