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General NPI Number Information
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NPI Number | 1023079688
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Entity Type | Individual
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Provider Name | GEORGE OTTO MABRY JR D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 12/27/2016
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Provider Practice Location Address
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Address Line | 2194 HWY A1A SUITE 108
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4930
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Country | US
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Telephone | 321-777-9559
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Fax | 321-777-9558
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Provider Business Mailing Address
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Address Line | 2194 HWY A1A SUITE 108
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4930
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Country | US
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Telephone | 321-777-9559
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Fax | 321-777-9558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | PO2788
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213ER0200X
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Taxonomy Name | Radiology Podiatrist
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License Number | JR3863700
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License Number State | FL
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