MEDICARE: GEORGE E NACKLEY M.D.

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	207R00000X	Internal Medicine Physician	ME0062609	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00136519	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	17917	OTHER	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922085943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE E NACKLEY M.D.

Provider Business Mailing Address
First Line	:	3434 HANCOCK BRIDGE PKWY
Second Line	:
City	:	N FT MYERS
State	:	FL
Zip	:	33903-7094
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2625

Provider Business Practice Location Address
First Line	:	2343 AARON ST
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5305
Country	:	US
Telephone Number	:	941-629-2900
Fax Number	:	941-629-6920

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	10/03/2013

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Directions to “ GEORGE E NACKLEY M.D.” Practice Location

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