MEDICARE: DR. ISAAC GEORGE ISAAC MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME105660	FL
2	2084P0804X	Child & Adolescent Psychiatry Physician	ME105660	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14AK9	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1063681773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISAAC GEORGE ISAAC MD

Provider Business Mailing Address
First Line	:	1750 17TH ST BUILDING N
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34234-8690
Country	:	US
Telephone Number	:	941-529-0200
Fax Number	:	941-260-8724

Provider Business Practice Location Address
First Line	:	1750 17TH ST BUILDING N
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34234-8690
Country	:	US
Telephone Number	:	941-529-0200
Fax Number	:	855-526-0216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	12/05/2024

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