Healthcare Provider Details

I. General information

NPI: 1457585317
Provider Name (Legal Business Name): GEORGE G KHOURI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FLAGLER DR SUITE 8100
WEST PALM BEACH FL
33401-3404
US

IV. Provider business mailing address

1411 N FLAGLER DR SUITE 8100
WEST PALM BEACH FL
33401-3404
US

V. Phone/Fax

Practice location:
  • Phone: 561-366-8300
  • Fax: 561-366-8320
Mailing address:
  • Phone: 561-366-8300
  • Fax: 561-366-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License NumberME62262
License Number StateFL

VIII. Authorized Official

Name: DR. GEORGE G KHOURI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-366-8300