Provider Demographics
NPI:1063519254
Name:VONHILSHEIMER, GEORGE EDWIN IV (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWIN
Last Name:VONHILSHEIMER
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2727
Mailing Address - Country:US
Mailing Address - Phone:850-233-3376
Mailing Address - Fax:850-522-8354
Practice Address - Street 1:922 MAR WALT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6630
Practice Address - Country:US
Practice Address - Phone:850-796-3376
Practice Address - Fax:850-522-8354
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108423207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007211900Medicaid
FL14F3UOtherBLUE CROSS BLUE SHIELD
AL178572Medicaid
FLFJ439YMedicare PIN
AL102I071319Medicare UPIN
AL178572Medicaid