Provider Demographics
NPI:1194709840
Name:DUVALL, GEORGE T III (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:DUVALL
Suffix:III
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 1:2312 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4109
Mailing Address - Country:US
Mailing Address - Phone:772-562-1275
Mailing Address - Fax:772-562-4630
Practice Address - Street 1:2312 20TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4109
Practice Address - Country:US
Practice Address - Phone:772-562-1275
Practice Address - Fax:772-562-4630
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027970207RC0200X
NC38607207RC0200X
AZ24530207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D54211Medicare UPIN
31095Medicare ID - Type Unspecified