Healthcare Provider Details

I. General information

NPI: 1508167073
Provider Name (Legal Business Name): GEORGE T. DUVALL III MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 20TH AVE
VERO BEACH FL
32960
US

IV. Provider business mailing address

2312 20TH AVE
VERO BEACH FL
32960
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-1275
  • Fax: 772-562-4630
Mailing address:
  • Phone: 772-562-1275
  • Fax: 772-562-4630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME0027970
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME0027970
License Number StateFL

VIII. Authorized Official

Name: DR. GEORGE T DUVALL III
Title or Position: PRESIDENT
Credential: MD
Phone: 772-562-1275