MEDICARE: CLETUS ROY GEORGES 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	208800000X	Urology Physician	ME73722	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q00261096	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932131752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLETUS ROY GEORGES MD

Provider Business Mailing Address
First Line	:	1420 CELEBRATION BLVD STE 308
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5161
Country	:	US
Telephone Number	:	407-566-9899
Fax Number	:	407-566-9893

Provider Business Practice Location Address
First Line	:	40107 HIGHWAY 27
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-5901
Country	:	US
Telephone Number	:	407-599-9899
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	12/27/2022

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