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NPI Code Detail

MEDICARE: GEORGE E PLATT MD

MEDICARE: GEORGE E PLATT 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
1332900000XNon-Pharmacy Dispensing SiteME54692FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11015482OTHEROTHER ID NUMBER
21015482OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1700820552
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGE E PLATT MD
Provider Business Mailing Address
First Line : PO BOX 10890
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32247-0890
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 705 FERRIS ST
Second Line :
City : GREEN COVE SPRINGS
State : FL
Zip : 32043-4025
Country : US
Telephone Number : 904-284-4510
Fax Number : 904-284-3293
Authorized Official
Title or Position : PRESIDENT
Name : JEFF BOGAN
Credential :
Telephone Number : 904-962-2123
Provider Enumeration Date : 06/15/2006
Last Update Date : 01/22/2008

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