Provider Demographics
NPI:1588741037
Name:SANCHEZ, GEORGE L (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:SANCHEZ
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 1:3028 4TH ST
Mailing Address - Street 2:B
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2127
Mailing Address - Country:US
Mailing Address - Phone:850-482-4655
Mailing Address - Fax:850-482-6694
Practice Address - Street 1:3028 4TH ST
Practice Address - Street 2:B
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2127
Practice Address - Country:US
Practice Address - Phone:850-482-4655
Practice Address - Fax:850-482-6694
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061139208000000X
IL036-076516208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
100328242008OtherHUMANA
004618500OtherAETNA
PR16598890001OtherCIGNA
FL018025OtherVISTA HEALTHPLAN INC
FL370461100Medicaid
FLNH112OtherHEALTHEASE OF FLORIDA INC
FL14785OtherBLUE CROSS BLUE SHIELD
PR16598890001OtherCIGNA
FLNH112OtherHEALTHEASE OF FLORIDA INC