Provider Demographics
NPI:1225065600
Name:GEORGE, ROSY (MD)
Entity type:Individual
Prefix:
First Name:ROSY
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 KINGSLEY AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5129
Mailing Address - Country:US
Mailing Address - Phone:904-272-7500
Mailing Address - Fax:904-272-7502
Practice Address - Street 1:2140 KINGSLEY AVE
Practice Address - Street 2:STE 1
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5129
Practice Address - Country:US
Practice Address - Phone:904-272-7500
Practice Address - Fax:904-272-7502
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00217656OtherRAILROAD MEDICARE
FL50997OtherBLUE SHIELD
FLME90526OtherMDCL LIC
FL50997OtherBLUE SHIELD
50997YMedicare ID - Type Unspecified