Provider Demographics
NPI:1104888429
Name:AZAR, GEORGE P JR (MD, PA)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:AZAR
Suffix:JR
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 N FEDERAL HWY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1907
Mailing Address - Country:US
Mailing Address - Phone:954-771-6047
Mailing Address - Fax:954-771-2927
Practice Address - Street 1:6333 N FEDERAL HWY
Practice Address - Street 2:SUITE 270
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1907
Practice Address - Country:US
Practice Address - Phone:954-771-6047
Practice Address - Fax:954-771-2927
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056075207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051568000Medicaid
FL051568000Medicaid
FL08915Medicare ID - Type Unspecified