=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164210233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL DOCTORS OFFICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2025
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 N HIGHWAY A1A STE D101
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33477-9513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-446-7400
-----------------------------------------------------
Fax | 561-879-4448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 OCEAN TRAIL WAY APT 1405
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33477-5528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-446-7400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. USHA GEORGE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 516-446-7400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------