Healthcare Provider Details

I. General information

NPI: 1295795813
Provider Name (Legal Business Name): GEORGE J FYFFE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 37TH PL SUITE 101 & 102
VERO BEACH FL
32960-6578
US

IV. Provider business mailing address

1000 36TH ST
VERO BEACH FL
32960-4862
US

V. Phone/Fax

Practice location:
  • Phone: 772-770-6116
  • Fax: 772-564-6120
Mailing address:
  • Phone: 772-567-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME 75129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: