Healthcare Provider Details

I. General information

NPI: 1881664951
Provider Name (Legal Business Name): GEORGE L RESTEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E MADISON ST
STARKE FL
32091-4043
US

IV. Provider business mailing address

132 E MADISON ST
STARKE FL
32091-4043
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-6500
  • Fax: 904-964-9170
Mailing address:
  • Phone: 904-964-6500
  • Fax: 904-964-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0049847
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: