Healthcare Provider Details

I. General information

NPI: 1689683104
Provider Name (Legal Business Name): GEORGE G KHOURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/06/2013
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 TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME62262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: