Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | ME 75129 | FL |
NPI | 1295795813 |
---|---|
Provider Name | George J Fyffe |
First Address | Vero Beach, FL 32960-4862 |
Second Address | Vero Beach, FL 32960-6578 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 19/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
254271400 | (05) | FL |
43603 | BLUE CROSS (01) | FL |
G71375 | (02) | FL |