Provider Demographics
NPI:1194925560
Name:BOCTOR, GEORGE G (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:G
Last Name:BOCTOR
Suffix:
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:PO BOX 23158
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33307-3158
Mailing Address - Country:US
Mailing Address - Phone:954-776-1180
Mailing Address - Fax:954-776-1181
Practice Address - Street 1:935 INTRACOASTAL DR
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3623
Practice Address - Country:US
Practice Address - Phone:954-776-1180
Practice Address - Fax:954-776-1181
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 99169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF267ZMedicare PIN